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Dr. Chris Holsinger shares the new guideline from ASCO on transoral robotic surgery (TORS) for patients with oropharyngeal squamous cell carcinoma. He reviews the evidence-based recommendations on baseline assessment, the role of TORS in HPV-positive and HPV-negative disease and in the salvage/recurrent setting, which patients are eligible or ineligible for TORS, and the role of adjuvant therapy. He discusses the importance of multidisciplinary collaboration and shared decision-making between patients and their clinicians. Read the full guideline, “Transoral Robotic Surgery in the Multidisciplinary Care of Patients with Oropharyngeal Squamous Cell Carcinoma: ASCO Guideline.”   TRANSCRIPT This guideline, clinical tools, and resources are available at asco.org. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology.   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts, delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts.    My name is Brittany Harvey and today I'm interviewing Dr. Chris Holsinger from Stanford University, lead author on “Transoral Robotic Surgery in the Multidisciplinary Care of Patients with Oropharyngeal Squamous Cell Carcinoma: ASCO Guideline.” Thank you for being here today, Dr. Holsinger. Dr. Chris Holsinger: Thanks, Brittany. We've been working together for years on these guidelines and what a pleasure to get to meet you at least virtually today. Brittany Harvey: Yes, it's great to have you on. And then just before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Holsinger, who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So let's jump into this important guideline. Dr. Holsinger, to start us off, can you provide an overview of both the scope and purpose of this guideline? Dr. Chris Holsinger: Absolutely. And again, thanks for the opportunity to be here, Brittany. I appreciate the invitation to participate in the ASCO Guidelines and to work with the great people on this paper that's now out there. I think it's a really important guideline to be published because it really talks about surgery, specifically transoral robotic surgery, a minimally invasive technique, as a new way to treat head and neck cancer. Why that's so important is that what is now known as head and neck cancer is completely different than what we saw even 25 years ago. Around the turn of the century, some really thoughtful epidemiologists working at Hopkins and UW in Seattle started to see this connection between the human papillomavirus and head and neck cancer. And since then we've seen this precipitous rise in the number of throat cancers specifically due to HPV. The results from the American Cancer Society showed last year that head neck cancer, in particular these cancers of the oropharynx, actually were one of the few cancers that still had an increasing incidence, I think it was around 2.5% per year. And other studies have shown that almost 50% of the cases we're seeing across the United States now are actually HPV-mediated throat cancers. That's bad news because we're seeing this rise in cases, but it's good news in the sense that this is a cancer that is highly curable and I think opens up a lot of different treatment avenues that we didn't have a couple of decades ago. And when patients are facing a mortality risk that's two or three times lower than the formerly HPV-negative smoking-driven cancers, it really behooves us as clinicians, as oncologists to think about treatment selection in a completely different way. And for years, the only function-sparing option, surgery certainly was not, was radiation therapy with concurrent cisplatin chemotherapy. In 2009, the FDA approved the use of surgical robotics using a transoral approach, a minimally invasive approach to resect the primary tumors and to perform neck dissection. And so now when patients walk in the door, they not only have this gold standard option in the path of radiation therapy with chemo, but also frontline surgery. And with some recent publications, especially the ECOG 3311 study, there's some really good evidence that for HPV-mediated throat cancers, we can actually de-escalate the intensity of adjuvant therapy when we start with surgery first. So who we choose that option for, which patients want that option - these are all really important new questions that we try to grapple with in these guidelines. Brittany Harvey: That background is really key for setting the stage for what we're about to talk about today. And so next I'd like to review the key recommendations across the clinical questions that the panel addressed. So you just talked about the importance of treatment selection. So to start that off, first, what is recommended for baseline assessment for patients with oropharyngeal squamous cell carcinoma who are being considered for transoral robotic surgery? Dr. Chris Holsinger: So I think here we tried in the guidelines to really standardize the workup and approach of this disease, in general, but with a strong focus on who might be a good surgical candidate. As I mentioned in the introduction, I mean, this is a disease that is very new. Our workup is in flux. And so what we tried to do, especially in items 1.2 and 1.3, is to really standardize and confirm that the tumor that we're dealing with, which oftentimes presents in a metastatic lymph node, is in fact associated with the human papillomavirus. So how biopsy is done, how high risk HPV testing is performed, whether you're doing that with an in situ hybridization, a DNA based study, or a p16 immunohistochemical study. And we try to tackle these issues first to really make sure that the patient population we're considering is actually indeed eligible for this kind of treatment de-escalation with surgery. Brittany Harvey: Understood. So it's important to consider which patients could be eligible for TORS upfront. So what is the role of TORS in patients with HPV-positive oropharyngeal squamous cell carcinoma? Dr. Chris Holsinger: Yeah, exactly. So I think first of all, surgery is ideally suited, and the robot is FDA approved for early-stage cancers - T1 and T2 cancers that are amenable to a minimally invasive approach. And we really try to emphasize, especially in our patient selection section of the guideline, who is really an ideal candidate for this. It's not just the T1 and T2 tumor. It's a tumor that is lateralized so that we can maybe consider managing the neck concurrently just on the side of the tumor, rather than doing bilateral neck dissection for most patients. Which patients might get the best functional outcome is a really critical component of this. And in fact, that actually goes back to a guideline that we didn't have time to chat about earlier, which is that we think every head neck cancer patient, whether or not they're being considered for transoral robotic surgery or frontline radiation therapy with cisplatin, every patient should have a pre-treatment assessment by a speech and swallowing expert. They're called different names across the country: speech language pathologists, speech pathologists, etc. But having a really good functional assessment of the patient's ability to swallow before treatment selection is really critical. And why that's important with frontline surgery is that there's a period of about one or two weeks after which that patient really needs intensive rehabilitation. And so for every patient being considered by TORS, we want to work really hand in hand with that speech pathologist to do pre-habilitation and then immediate post-operative rehab and then long longitudinal rehabilitation so that if radiation is needed down the road in a month, that patient just hopefully sails through this de-escalated treatment that we're offering. Brittany Harvey: Great. I appreciate you describing which patients can be considered for transoral robotic surgery. So beyond that, which patients with HPV-positive oropharyngeal squamous cell carcinoma aren't really good candidates for TORS? Dr. Chris Holsinger: We talked about that sort of ideal patient, but you know, we're not always living in an ideal world. And so I think it's important, and I'm really happy about the multidisciplinary discussions that led to these final guidelines because I think it helped engage radiation oncologists, medical oncologists, and surgeons around who's maybe not a good candidate for this because radiation therapy, with or without cisplatin chemotherapy, remains a good option for many of these patients. But I think the consensus, especially among the surgeons in this group, were that patients with tumors were more endophytic - that's the old fashioned oncology and surgical oncology term that refers to tumors that seem to not be as evident on the surface and have more of an infiltrative deep growth pattern - these are not ideal tumors. Whereas an exophytic tumor that's growing upwards, that's more readily seen on flexible endoscopy during a routine clinic assessment, or frankly, better seen on imaging, those exophytic tumors are better suited to a surgical approach because the surgeon has a better chance when he or she sees the tumor to get a good margin. When we can appreciate not just the surface mucosal margins that need to be taken, but also have a better chance to appreciate their depth. And with those infiltrative tumors, it's much harder to really understand how to get that deep margin, which in many cases is always the hardest. And so that's a long way to say that surgical decision making, patient selection is really critical when it comes to offering TORS as a multidisciplinary group. And then there are a few other things that we can quickly talk about before we move on to discussing adjuvant therapy. But I think there are some relative contraindications to patients who might have tumors arising in a palatine tonsil or tonsillar pillar, but which might grow significantly into the soft palate, such that a major palatal resection would be needed to get a good margin. For T1 and T2 tumors, we're not sure that that is an ideal candidate. And the other relative contraindication, but it's a hard and fast contraindication in my personal practice, is patients with extensive nodal disease. I think a patient who has preoperative extranodal extension, matted nodes, clinically and on MRI, you know pre-op they're going to need intensive post operative concurrent chemoradiation post-op that's maybe not the best patient for TORS, although there are some select cases where that that might make sense. But that's a quick overview of patient selection for TORS, Brittany. Hopefully, that's helpful. Brittany Harvey: That's definitely helpful. I think it's really important to consider not only who is eligible, but who isn't eligible for this de-escalation of treatment, and I appreciate you clarifying some of that. So then you've just also mentioned adjuvant therapy along with multidisciplinary discussion. So what is recommended regarding adjuvant therapy for patients who have resected HPV-positive oropharyngeal squamous cell carcinoma? Dr. Chris Holsinger: Definitely. And I think the post-operative discussion has to begin with great pre-op planning. And pre-op planning is really anchored in a really robust multidisciplinary team. So, we spoke earlier about the critical importance of getting speech language pathology involved initially, but they're part of a much larger team that includes not just a surgeon, but medical oncologist, a radiation oncologist and a dental oncologist - all of these specialties, and I could think of several others if we had time to chat further - this should also be really engaged in the care of these patients. But great decision making regarding adjuvant therapy really begins with a robust multidisciplinary consultation pre-op and we try to emphasize that in the guidelines. But just to return and answer your question very directly, I think adjuvant therapy is really the critical piece in getting that great functional outcome for a patient with HPV-mediated throat cancer. And I think traditionally patients who have a variety of different risks, based on a large study done again by the ECOG group, ECOG 3311, we showed that by stratifying patients based on their surgical pathology rather than on an estimate of disease extent, we can better stratify adjuvant therapy. And so the low risk patient is a patient with good margins and of course, good margin, we could spend another two hours discussing that. But good margins are greater than at least 1 to 3 millimeters superficially and a clear deep margin. Patients with lymph node metastases that are less than 3 cm and a single lymph node can sometimes be observed but most patients don't fall into that low risk category. Most patients fall into an intermediate risk where the margin is good and it's clear, but it might be close. That depends if you're talking about the superficial mucosal margin or the deep. But more often than not, we spend a lot of time considering the extent of lymph node involvement as it pertains to how adjuvant therapy is delivered. And I think for patients with less than 4 lymph nodes traditionally without extranodal extension, radiation therapy will suffice for adjuvant therapy after TORS. And the question of dose then comes up. Are we talking 50 Gray, the experimental arm that showed real promise in the ECOG 3311 trial, or 60 Gray or more traditional dose? And that is a topic definitely for another podcast, which we should do with a radiation oncologist online. I don't want to get into the weeds with that, but I refer you to our guidelines and Bob Ferris and Barbara Burtness' paper from JCO in 2021 for further details about that. But then for patients with positive margins with more than four lymph nodes, but especially patients with extranodal extension, the role of radiation therapy and chemotherapy is really absolutely critical. Because these patients and while they only accounted for around 20% to 30% of patients that we're seeing in this new era of TORS, they're the ones that we're really focusing on how can we do better because their overall survival is still good, it's 90%, but it's not as good as the patients we're seeing with a low and intermediate risk. So that's a brief overview there. Brittany Harvey: I appreciate that overview. And yes, we'll refer listeners to the full guideline, which is linked in the show notes of this episode to learn more about the intricacies of the radiation therapy that you mentioned. So then we've talked a lot about patients with HPV-positive disease, but what is the role of TORS in patients with HPV-negative disease? Dr. Chris Holsinger: I think TORS still has a role for these patients. Our colleague in India, Surender Dabas, has a really nice series that shows that for HPV-negative patients, this is a way for early stage cancers to potentially escalate the intensity of treatment for a disease that does worse than this new HPV-positive we're seeing in the US. So I think there's a good signal there. I think more study needs to be done and I think those studies, in fact, are underway in India and other countries. I hope that we can, as an oncology community here in the United States, also tackle this disease, which is still a significant part of the disease we face in head and neck oncology. Brittany Harvey: Yes, we'll look forward to more data coming out for HPV-negative disease. So then, the last clinical question that the guideline panel addressed: What is the role of TORS in the salvage or recurrent setting? Dr. Chris Holsinger: So we wrap up the guidelines tackling this topic. It's definitely something for the experienced TORS surgeon in consultation with that multidisciplinary team. Oftentimes, we are still seeing many patients who need salvage surgery and I think, while TORS alone could be a really effective treatment option, TORS with a microvascular reconstruction is oftentimes what is needed for these patients who, with recurrence, do often present with an RT 2, 3, 4 tumor. In my own practice, I found that using TORS as a way to minimize the superficial mucosal extent and then delivering that tumor through a traditional lateral pharyngotomy, then neck dissection and then having a microvascular flap inset done after that really provides the best possible chance for good long term function and of course control of the tumor. Here, I definitely refer the listener to some great work done out of the Royal Marsden with Vin Paleri, who we're happy to have on our TORS guideline panel for his RECUT study that really grapples in some detail with these very issues. Brittany Harvey: Excellent. And so we've covered a lot of the recommendations here that were made by the panel and you've touched a little bit about how this changes things for clinicians in practice. But what should clinicians know as they implement these new recommendations? Dr. Chris Holsinger: One thing as we close, I hope that in the future we can really start to grapple with this concept of patient selection. I think these guidelines help establish that TORS is a great oncologic option with - really the only option for treatment de-escalation in the here and now. Radiation therapy and cisplatin concurrent chemotherapy is going to be an option that is such an important choice for patients. And I think where I hope the field goes in the future is figuring out which patient wants one of these options. And I think certain patients really want that tumor taken out and others just the idea of surgery is not something that makes sense for them. How we in the context of a multidisciplinary team, really engage that patient, elicit their treatment preferences and then through considering treatment eligibility criteria that we've spelled out here for surgery and can be spelled out for chemo RT, bringing all that together in a formal shared decision making process is really where I hope the field will be going in the next few years. And hopefully these guidelines help to pave the way there. Brittany Harvey: Definitely the aspect of care by a multidisciplinary team and talking with patients to go through shared decision making is key to implementing these guidelines. So then, in that same vein, what do these recommendations mean for patients with oropharyngeal squamous cell carcinoma? Dr. Chris Holsinger: I think the central take home message for patients should be that especially if you have a T1 and T2 tumor, it's really important to have that consultation with a surgeon who knows how to do TORS and has a busy practice, but then also having an honest discussion up front about what the functional outcomes would be both with surgery and also chemo RT. And I think just knowing all those different options, that multidisciplinary treatment selection process is going to be that much more robust. And I think more right decisions will get made and we'll see less decisional regret down the road, which I think is a long term goal of our field. Brittany Harvey: Absolutely. That discussion of preferences is key. So then to wrap us up, you touched on this a little bit earlier in talking about ongoing research and data, particularly in the field of HPV-negative disease, but what are the outstanding questions regarding TORS in this patient population? Dr. Chris Holsinger: Yeah, I think that in addition to this work around shared decision making, I really hope that we'll embrace shared decision making in the context of future clinical trial. I think where we are now is you have surgeons saying, “Hey, TORS and 50 gray is a great option. Why aren't we doing that?” And then our colleagues, perhaps across the aisle, if I can use a political metaphor, are saying, “Well, where's the comparative data? Can we even do a randomized clinical trial between surgery and radiation?” Well, Christian Simon in Lausanne in Switzerland is trying to do this in a small pilot study being led by the EORTC, and I would encourage American investigators to consider something analogous. But I think how we solve this question of I think treatment choice is going to be pivotal for any such trial to ever be done. And then finally, I think, how will the changing treatment landscape around immunotherapy change this? There's some really provocative data that dates back to 1996 in a JCO paper from Ollivier Laccourreye and the University of Paris experience that showed induction chemotherapy followed by function preserving surgery in the larynx was a really powerful strategy for organ preservation, and that has never been followed up in the United States. And so especially with the upcoming presentation of KEYNOTE-689, will we be doing neoadjuvant approaches for patients and then following them by minimally invasive surgery or lower dose radiation? I think these are going to be some exciting new areas of study and I can't wait to see how this might evolve so we can refine the treatment - still get those great outcomes, but reduce those late toxicity. Brittany Harvey: Yes. We'll look forward to this ongoing research to continue to move the field forward. So, Dr. Holsinger, I want to thank you so much for your time to develop this important guideline. It's been great to have you on the podcast to discuss it today. Dr. Chris Holsinger: Well, thanks a lot Brittany. It's nice to finally meet you. Brittany Harvey: Likewise. And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/head-neck-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

Introduction: Minutes 0 to 4:00 I am recovering well from a hysterectomy. Chandra had a stomach virus last weekend which is why we didn't publish on Sunday Oscar nominated movies we watched: Minutes 4:00 to 13:30 There are no spoilers in this section. We both loved Conclave as we discussed in the last episode. I want it to win best picture. I saw Emilia Perez before the controversies and I really liked it. We both saw Wicked. Chandra liked it more than I did. She loved Anora and wishes that Mikey Madison would have done a bigger Oscar campaign. We both hated The Substance and wonder why it's getting so much buzz. We both saw A Real Pain and liked it. We wonder why Denzel Washington wasn't nominated for his performance in Gladiator II. Chandra liked Maria and was hoping Angelina would be nominated. She saw A Complete Unknown and thought Timothee Chalamet was great in it. I highly recommend Day of The Jackal on Peacock and am watching Paradise on Hulu. We're both watching the second season of Severance. Royals: Minutes 13:30 to 22:15 In early January we got the announcement of Duchess Meghan's new lifestyle show on Netflix called With Love, Meghan. She's also back on Instagram. Her show was supposed to premiere on January 15th, but was delayed until March 4th due to the terrible wildfires in Los Angeles. NGN settled with Prince Harry on the day the trial was supposed to start. If Harry hadn't taken the settlement, it would have altered the case. This was a win for Harry since NGN admitted guilt. Harry's security case is still in the courts. The Invictus Games are going to be February 8th to the 16th in Vancouver. We hope Meghan is there most of the time, but we'll see. The Vanity Fair cover story on Harry and Meghan came out a couple of weeks ago. It's very similar to the British narrative we've been hearing about their relationship for years now, and it's insidious and despicable. Chandra wrote some good analysis about how the piece was meant to tear Harry down before he testified against NGN. Princess Kate and Prince William have done so many events this week. Kate's surprise visit to Royal Marsden hospital on January 14th was curiously timed. Politics: Minutes 22:15 to 29:30 Following the horrific plane collision between a US Army helicopter and a commercial flight, Trump did a press conference and blamed DEI policies. Both the plane crash and the response by Trump were predicted by a University of Maryland political science professor. He tweeted on January 29, a day before, that there weren't enough air traffic controllers and that Trumpers would blame a crash on DEI. Trump had recently fired the head of the FAA and put a hiring freeze on air traffic controllers. We're frustrated at people asking Democrats to do something. It will probably take some time before people realize that they were wrong to vote for Trump. Comments of the Week: Minutes 29:30 to end Chandra's comment of the week is from SussexWatcher on the post about Prince William visiting a farm. My comment of the week is from Rai on the post about Chappell Roan. I didn't delete the comment I was responding to, it was just at the bottom and I missed it when we were recording. Thanks for listening bitches!

Welcome back to the "Sutton United Talk Time on Podcast" (or "Sutton Podcast" for short). In this episode, we're diving deep behind the amber curtain with Matthew Disley, Sutton United's Commercial Manager, to explore his role, journey, and his strategic vision for the club's commercial operations.Introduction Hello and welcome to another episode of the Sutton Podcast in association with Lucky Star Gin. I'm your host, Mike, and today we're excited to introduce Matthew Disley. We'll be covering Matthew's role, his story so far, and his hopes for his impact at Sutton United. Let's dive right into it!Overview of Matthew Disley's RoleBrief Biography: Matthew's background in fitness, sales, and marketing, including his role as a commercial site manager at Go Ape and commercial manager at Grimsby Town.Joining Sutton United: Motivation for joining Sutton, even with the expectation of relegation, driven by the opportunity to effect significant changes.Role and Responsibilities at Sutton UnitedCommercial Director Overview: Explanation of the commercial director role, focusing on generating revenue through various sponsorships and partnerships.Strategies for Engagement: Techniques for securing renewals and broadening the horizons to attract national sponsors.Immediate and Long-term GoalsImmediate Goals: Professionalizing operations, ensuring proper contractual agreements, and introducing price increments.Long-term Vision: Aim to attract national companies, leverage digital opportunities, and potentially introduce LED boards, contingent on increased revenue.Community and Fan EngagementBalancing Change with Tradition: Importance of transparent communication and involving fans in the journey to maintain the club's charm while fostering professional growth.Fan Participation: Encouraging fans to help by engaging employers for sponsorship, buying programs, and supporting through social media interactions.Personal Stories and Additional InsightsVisiting the Royal Marsden: Emotional experience during the visit and related fundraising efforts through running a half marathon for the Royal Marsden.Potential Partnerships: Mention of engaging with organisations like Chessington for potential future collaboration.Message to FansCommunity Focus: Emphasis on the critical role of fans in sustaining and growing the club's revenue.Call to Action: Encouraging fans to bring friends and family to games and get involved in any way they can, reflecting Sutton United's community spirit.Through these chapters, the interview provided a comprehensive view of Matthew Disley's professional journey, his strategic approach to his role, and his commitment to integrating fans into the club's evolution. Hosted on Acast. See acast.com/privacy for more information.

Darren travels to Hummelo in the Netherlands to meet Piet Oudolf at his home and studio. Piet talk us through his process, how the work has changed over the years and why he was excited to work with Maggie's on his garden at The Royal Marsden centre.  Check out more of Piet's work at his website here To find out more about Maggie's visit their website here To find out more about Darren Hawkes see the link here The Garden Design Confessional is produced by Karen Pirie

Chat with the cutting-edge Surgical Oncologist at the Royal Marsden hospital in London, who is from Galway and who recently featured in the reality documentary series ‘Super Surgeons: A Chance At Life' on Channel 4

This episode is one that sees Vicky and Damian talking to a Medical Oncologist (Dr Kate Young) from the Royal Marsden about the topic of fever in the immune suppressed or neutropenic patient, we hope you find it useful and watch out for future Oncology themed episodes coming in the future.

What do clinicians need to know about diagnosing skin cancer in a person of colour? Why is it important for clinicians to address fear of cancer recurrence? What are some key points from the latest consensus statement on hypothyroidism?In this episode of the Clinical Update podcast, MIMS Learning editors look at important considerations for diagnosing skin cancer in people of colour. Our guest for this episode Dr Susanne Cruickshank, who is strategic lead for applied health research at Royal Marsden, discusses fear of cancer recurrence and how healthcare professionals can begin to address it. F Finally, we will look at some of the main takeaways from the British Thyroid Association/Society for Endocrinology consensus statement for hypothyroidism.You can visit the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.Useful linksSkin cancer in skin of colourSkin cancer in skin of colourDermatology for skin of colour learning planCancer recurrenceFear of cancer recurrenceManaging the oncology patient's expectationsHypothyroidismDiagnosis and treatment of hypothyroidismRegister to access contentRegister for a free MIMS Learning healthcare professional account Hosted on Acast. See acast.com/privacy for more information.

On today's episode of the G Word, our guests will be discussing the CanGene-CanVar programme. Funded by Cancer Research UK, the 5-year programme aims to create an interface between NHS clinical care and research that will expand genetic testing access for those with inherited cancers. Our host Amanda Pichini, Clinical Lead for Genetic Counselling at Genomics England, is joined by Dr Helen Hanson, Consultant in cancer genetics at the Peninsular Regional Genetic Service, Kelly Kohut, Lead Genetic Counsellor at the South West Thames Centre for Genomics, and Rochelle Gold, Patient Representative on the CanGene-Canvar research programme and co-founder of BRCA Journey.   "There is also the possibility of finding out genetic information that's familial or inherited, which could mean that the information is not only important for the person who is being treated for cancer at the current time but also as a next step informing relatives that they might have a higher chance of getting cancers in the future due to a genetic variant..."     You can read the transcript below or download it here: How-are-genetic-tests-transforming-cancer-prevention.docx   Amanda: Hello and welcome to The G Word.  My name is Amanda Pichini and I'm the Clinical Lead for Genetic Counselling at Genomics England.  We know that cancer is a very common disease.  About one in two people will develop cancer at some point in their lifetime.  Cancer is a disease of the genome involving many changes to a person's genome over time as well as other factors.  Only a small proportion of all cancers are inherited, but this can have a significant impact for those families who have a much higher risk of cancer and options to reduce their risk.    Today I'm delighted to be joined by Dr Helen Hanson, Consultant Clinical Geneticist; Kelly Kohut, Consultant Genetic Counsellor; and Rochelle Gold, Patient Representative and co-founder of BRCA Journey.  We'll be discussing the CanGene-CanVar programme which aims to link NHS clinical care and research to expand access to genetic testing and care for people with inherited cancers.  Welcome, Rochelle, Helen and Kelly to The G Word.  Thank you for joining me today.  Let's start with some introductions.  Rochelle, over to you?  Rochelle: Hi, everyone.  I'm Rochelle and I'm one of the Patient Reps on the CanGene-CanVar research programme.  I also co-founded an organisation called BRCA Journey that helps to raise awareness of the BRCA genetic mutation amongst both clinicians and the community, and also supports people who might be at risk of the mutation or who are thinking about testing, all the way through to maybe having preventative treatment or preventative surgery.  We support those with that decisions.  We're not genetic counsellors but we do basically talk to people about our experience and knowledge that we have of what it's like as a patient to be someone living with the mutation.    Amanda: Thank you.  Could you briefly tell us what BRCA is and how you came to be a patient?  Rochelle: BRCA is a genetic mutation that puts people at greater risk of breast and ovarian cancer.  My mum had the mutation, in fact she had two of the mutations which is apparently quite rare.  She passed away from breast cancer and just before she passed away I found out that I had the genetic mutation as well.  I personally have had preventative surgery and reconstruction to prevent myself from getting breast and ovarian cancer.  I got involved in being a patient rep so that I can advocate for people who may have the mutation, but also make sure that as many people as possible can be tested and be aware that they have the mutation and have that power to have the knowledge to be able to do something about it should they so wish.  Amanda: Thank you so much for sharing that with us.  Kelly, over to you?  Kelly: Hello, everyone.  I'm Kelly Kohut, I'm the Lead Consultant Genetic Counsellor at the South West Thames Centre for Genomics, which is based at St George's Hospital in London.  For many years I've been working in clinical practice in genetic counselling, seeing patients and their families regarding personal or family history of cancer, offering genetic testing where that's available, and then giving the results and helping to refer people on for surveillance programmes and to discuss risk reducing options, and also help a lot with communication within families, sharing the information from the genetic test results.    For the past few years, I've also been doing my own research as part of the CanGene-CanVar programme, funded by the charity Cancer Research UK.  This has involved partnering directly with patients and other expert stakeholders to co-design a patient website to support decision-making around the genetic chances of getting cancer in families.     Amanda: Thank you.  And Helen?  Helen: Hi, everyone.  I'm Helen Hanson, I'm a Consultant in Cancer Genetics.  I'm based at the Peninsular Regional Genetic Service which is in Exeter.  In my clinical practice I see patients who either have a cancer diagnosis to consider whether they may have an inherited susceptibility or people who maybe have a family history of cancer to try and determine if they are at risk due to their family history.  Like Kelly and Rochelle I've also been involved in the CanGene-CanVar programme for the last four years.  I've been involved in work package three of the programme which is developing clinical guidelines with the patients who have an inherited predisposition to cancer.  I was also fortunate enough to be given some funding to carry on with this work beyond the programme in the new NIHR Exeter Biomedical Research Centre.    Also, I'm currently chair of the UK Cancer Genetics Group, who has an aim of improving the management of patients who have an inherited predisposition to cancer.  It's been really great to work on all these different things and try and bring things together to try and improve care for patients who do have rare inherited genetic conditions predisposing to cancer.   Amanda: Fantastic.  Thanks, everyone.  Kelly, I wondered if you could start us off by just explaining a little bit more about how genetics and genomics is relevant to cancer.  Especially inherited cancers, why is this an important thing to talk about?  Kelly: The availability of genetic testing has been increasing steadily over the years.  Currently from pretty much anyone who's been diagnosed with cancer there should be some awareness around the possible benefit of knowing the genetics behind the development of that cancer and whether any genetic or genomic testing might help to choose more personalised treatments or surgical options for that cancer that's been diagnosed.  There is also the possibility of finding out genetic information that's familial or inherited, which could mean that the information is not only important for the person who is being treated for cancer at the current time but also as a next step informing relatives that they might have a higher chance of getting cancers in the future due to a genetic variant and that they could ask their GP for referral to genetics to be offered genetic testing and to find out about their chances of getting cancer and the choices for how to manage that.    Amanda: Thank you.  There are clearly some important things that someone would do differently when they know they have an inherited cancer.  Helen, how can we make sure that clinicians and patients and families know what do to in these situations?  Helen: Following on from Kelly explaining the amount of genetic testing we can offer has really increased over the last five to ten years and we're not in a position to offer many more patients genetic testing, it's important that we also consider what to do with that information when we discover somebody does have a pathogenic variant or a mutation in a cancer predisposition gene.  There are over 100 different cancer predisposition genes described and actually having a variant in one these genes is rare.  It's difficult and like other conditions in medicine due to their rarity to really understand how best to manage these patients.  But what's very important is that we try to understand how best we can help patients manage their cancer risk based on the lifetime risk of cancer and the particular cancers that they can develop and ensure that patients across the country are all being given the same advice, the same information about their cancer risks.    Through the CanGene-CanVar programme we've had a whole work package which is devoted to clinical guideline development where we've looked at a number of these genes and looked at the evidence that is available in terms of cancer risks, the utility of surveillance or early detection of cancers in that condition, and also whether risk-reducing surgery could be offered.  Really try to bring together groups of experts to discuss the evidence because for some genes it really is quite limited due to the rarity of the condition.  The overarching aim is really to develop guidance that is relevant and can be offered in our current clinical practice and is consistent to all patients who have a variant in one of these genes.  Amanda: You mentioned that many of these inherited cancer conditions are very rare. Is there a need to look internationally or collaborate internationally?  How do you pull some of these things together when there's so little information?    Helen: We definitely have found it really helpful to have international collaborations.  Some of these conditions there may be very few patients in the UK who have this condition, so each individual clinician who works in cancer genetics may have only seen one or two patients with the condition than themselves and, therefore, collaborating with international colleagues has been very helpful and we have recently published some guidance for a condition BAP1 tumour predisposition syndrome which increases an individual's lifetime risk of developing mesothelioma, which is a type of lung cancer, renal cancer and melanomas of the skin and eye.  This is a rare condition, but we worked with European colleagues to develop a set of guidelines advising what surveillance the patient should have, so looking to melanomas, looking for early detection of kidney cancers, so having that international collaboration has been really very helpful because in the UK there are so few cases per centre of individuals who have that condition.     Amanda: That sounds really helpful.  Rochelle, we know that shared decision-making is so important in healthcare.  How can we make sure that the voices of patients are reflected within these guidelines that were developing and that it's clear to them what needs to happen for their healthcare?     Rochelle: I think it's really important that patients are involved in the development of the guidelines, first of all, and actually within those guidelines there is stuff that talks about that, being about shared decision-making.  A lot of these guidelines are in a language that are quite a clinical language that is not necessarily accessible to patients themselves.  It's really important that they're part of the creation of them but also that there are things out there that enable people to understand what are these guidelines about, what do these guidelines actually mean in practice.  When you find out that you have a particular genetic mutation, of course, the first place you probably go is Google.  You find a hell of a lot of information and you find all sorts from different countries and different people and different organisations.  You're like which is the thing I need to look at, which is the thing that actually tells me what's going on, which is the thing that really helps me to understand what this actually means for me and what should happen to me?  What is the pathway for me, etc.    I think we also need to recognise that people have different levels of health literacy as well.  I am someone who can probably navigate my way around a very complex system, which is the NHS, maybe better than other people.  But there are plenty of people out there who this is new people, this is a completely new thing that's happened to them, a completely new thing to understand.  If you're not used to being part of health systems and navigating your way around it, it can be quite scary.  What does mutation mean?  What does it mean for me?  What does it mean to my future?  What does it mean for my family?  All this information.  There needs to be something somewhere that talks about this, some sort of lay way and helps people to understand what this means for them and helps them to engage with it.  To some extent, that's where my organisation was born from, that thing about having somebody who can just talk about it in normal words, in normal terms and normal views of what these guidelines actually do mean.  The fact is they are just guidelines, they don't tell you this is what you do.  You're this person, you're in this circumstance, you do this, it doesn't.  There's some ambiguity there that needs to be navigated by the patient and they need support in order to do that.  Amanda: That's a great point.  Having previously worked as a genetic counsellor, also seeing patients with inherited cancer conditions, it really strikes you how individual each person's journey and decisions are.  They're thinking about all kinds of factors in their life or in their family's life.  Navigating through that and understanding do I have surgery or do I have screening and how do I make decisions about this is based on my previous experiences and so many other factors.  Having access to different sources of support to help people navigate through that feels incredibly important.    We've been talking a bit about inherited cancers in general, but you're all here because you're involved in the CanGene-CanVar programme.  Kelly, could you tell us a bit more about what that is and what he programme is aiming to achieve?  Kelly: The CanGene-CanVar programme is a five year grant funded by Cancer Research UK.  It involves six different work packages, so lots of experts all around the UK have been allowed to have some dedicated time to work on specific areas where there hasn't been enough resource put in in the past which has resulted in a real gap between the research and the current findings and actually using that information to benefit patients by bridging the gap and putting those research findings into clinical care.    My programme is in work package four which is co-designing patient resources which are decision support interventions.  Basically, it's a website and it can be printed as a booklet and it's interactive and it's up to date and it's personalised to help convey the complicated information about genetic cancer conditions in a way that's meaningful and patients can understand, and it helps them with their personalised shared decision-making.  The CanGene-CanVar programme is underpinned by the patient reference panel and they've been involved, including Rochelle and others, from the conception of the idea of the programme and all the way through with various different activities helping to look at documents as they're developed, before their finalised, and giving input in focus groups and one-on-one and email conversations.  They're called upon frequently to share their lived experience and say what's important to them when they make decisions and that's really helped to drive the direction of the research and inform the results before they're published.     Amanda: That sounds like a really helpful approach to developing something in a way that's really working very closely with patients and participants.  Rochelle, it sounded like you were involved in that.  Can you tell us a bit about what that was like from your perspective?  Rochelle: It's really rewarding, it's really motivating to be actually one of the patient reps in relation to this.  I don't want to make my colleagues from the team blush, but it's just such an inclusive environment where as a patient is really welcomed, really heard, it's very much a partnership and that's been really, really important and it makes you feel valued as a patient and actually the importance of the lived experience the patient view has really been prominent in this.  I would say that's why it's helped develop such a useful tool, the fact as a patient people are really valuing and taking into account our lived experience, our views, our understanding.  It's been quite fun in some of the sessions.  There have been some good debates between us and some of the clinicians and it's been really good and really useful.  I think some of the people who maybe haven't encountered a patient panel before and engaged with patient's lived experience have probably learn a lot from it because we are pretty empowered to use our voice in this.  It's been a really great experience.   Amanda: I'd love to dig into those debates a bit more.  Kelly, were there things that you changed in the decision aid as a result of some of those discussions or as a result of that input that maybe surprised you?   Kelly: We have made changes based directly on what we've learned from the patients presenting their lived experiences.  They've been very open and honest with us.  Like Rochelle, I felt so privileged to be part of this real partnership with the patients.  As a genetic counsellor who had many years of experience in clinical practice before moving into this research role, I've been really surprised but also gratified by how much I've been able to learn from the patients in a different way because I am sort of taking a step back, I'm there as a researcher and not directly as a clinician looking after someone one-on-one in clinic and just thinking about their specific needs at that time.  But because I'm hearing from people from all different situations, different parts of the UK and other countries and maybe it's 10/20 years since they had their genetic diagnosis are actually getting a bigger picture of their care needs that we might not have heard about as the clinicians on the ground because they might not be coming back to tell us.  If we haven't opened the door to that conversation about their personal situation or who's influencing them or what's important to them when they make decisions, we just might not have learned about the thing they're grappling with and they've gone off and maybe Googled, they've found a patient support group or something else to support them.    In my research and in my interviews and the focus groups, all of the activities I've been learning about the gaps in care, what might be needed to address that.  The decision aid has not been yet ruled into clinical practice but we're very keen to get it out there and everyone wants it and wants to use it.  We want to make sure that we've developed it in a robust patient-centred way as much as we can for us before we put it out.  It will always be updated and go through refinements, but hopefully in the New Year we will be able to let people start using it in the real world situation.  Amanda: That's great, I'm sure you're looking forward to that.  Helen: I was just going to add to that in terms of the guideline development we've had a number of consensus meetings where we've made decisions about guidelines, for example, genes that can be predisposed to ovarian cancer and we've included patients from the patient reference panel and from other patient groups in those consensus meetings.  Again, as Kelly said, that's been so helpful because it's really brought something to those discussions and it is a different perspective than when we see patients in clinic because often we're seeing them at the point of genetic testing or maybe for their results, but actually that doesn't give us that overview of the whole patient journey and the whole patient experience.  I think that has been really one of the benefits of this programme and Kelly has been really pioneering the co-design of patient information leaflets, decision aids with patients.  Rather than clinicians designing things for patients that we think that they will understand, it's actually working with patients from the start to get things right the first time.  It's been a really great part of this programme.  Amanda: Rochelle, did you want to add something further here?   Rochelle: Yes.  I think one of the sessions that we had as a patient and clinician and researcher session that really stood out for me was when we started looking at how do people make decisions. We had academics and researchers who've looked at how do people make decisions, talk about the knowledge base and the research base that we have about it.  As a larger group of patients we got together to discuss about how have we made decisions.  It was really interesting because I don't think I've ever reflected on how I made the decision and what came from that in terms of what I did about having my mutation.  Hearing about how other people did as well, that session really does stick in my mind and actually I learnt a lot as a person about decision-making theory but also about myself and reflecting on how I make decisions.  So as a patient involved in this, it's not always about what I bring to this but actually as a patient rep you get a lot from it, too.  I've learnt a lot from the colleagues that I've worked with.  Amanda: That's fantastic.  It's really great to hear the careful thought that's gone into this, a real excellent example that hopefully others can look to.  I think, Kelly, hasn't your work won an award recently as well?  Kelly: We as a whole team won an award from the academic health science network and the NHS Confederation, it's called the Innovate Awards 2023.  This was for excellence in patient and public involvement in transformation and innovation.  Yes, it was a chance to showcase the really positive experience that we've had.  I think on all sides we've learnt a lot from each other and just to hope to inspire other researchers and clinicians to take this co-design approach with patients because we all benefit from it so much.  We think that the resources, the guidelines, everything that we develop will be better from the start if we work together throughout the project.    We're really hoping to encourage others to consider from the beginning of their idea about a research programme or clinical development to bring the patients in right at the start, because they can really help to guide where things go next and then throughout.  Even through to publications being on, committees, being co-chairs, presenting together at conferences, that can all help to really share the experience and the benefits that we get from the partnership.  Amanda: That's great, congratulations.  Coming back now to some of the aims of CanGene-CanVar and trying to bridge that gap, as you said, between research and clinical care, I guess that means there are some needs that still aren't being met that are falling through that gap at the moment.  Helen, from your perspective what are some of those unmet needs that we currently have or areas that are still needing improvement?    Helen: I think there's still lots that we have to learn, particularly about individual risks for patients.  We might have patients who all have a pathogenic variant in a certain gene but their risks might be slightly different due to factors that can modify their risk.  Trying to understand some of those risks better so that we can really have much better informed discussions with patients about their lifetime cancer risks I think would be really helpful.  Work package one of the programme is really focussing on that and looking at some of the information we have through national registries and trying to understand risks for specific genes better, which will help our discussions with patients, and then we still need to understand, which is more outside the programme, more how surveillance, so early cancer detection through screenings such as mammograms or ultrasounds for different cancers can help detect cancers early. There's still lots of information that we need to learn.    I think Kelly's decision aid which has been focussed on Lynch Syndrome, I think that can be translated across lots of other genetic conditions, because for each gene there is a different set of decisions.  For some of the genes that we developed clinical guidelines for we might be recommending slightly different management or for some of the genes we've recommended maybe a minimum and an extended level of surveillance, particularly for a gene called DICER1 where we've offered different options in childhood.  Decision aids would potentially help in some of those other genes building on the work that's already been developed as part of the programme.  Although the programme is coming to an end in the next year, I think there's still lots of work to be done in this area.   Amanda: It really sounds like you've all been collectively improving how much this work is worthwhile, so that's great to hear.  Rochelle, how about for you, are there areas that you would see as unmet needs or areas where we or research can improve to help patients and families with inherited cancers.  Rochelle: Similar to some of the stuff that Helen was saying, knowing more about what happens when people have different types of treatment, different types of surveillance and monitoring and stuff like that, I think there are things that are evolving all the time.  I think in the end when you think about gaps, there's nothing that's going to be written down on paper that says if you have this, do this.  In the end, every single patient is an individual with individual circumstances.  I think until we actually know that if you do this, this happens and this happens, this is going to be your chances of survival if you go through this route.  Even then when you've got the chance of survival, that's literally just a probability, it's not a binary this will happen or that will happen.  There's always going to be a need for discussion, there's always going to be a need for these brilliant genetic counsellors that we have to talk us through some of those complex decisions that we have to make.  I think, yes, we'll get more information, we'll get more evidence, we'll get more understanding of treatments that work best for different people, and we'll get it out there and we absolutely do need to do that.    Even when you have all the information you need, even if you made a solid decision, I mean, when I found out I had the mutation immediately I was like, right, that's it, I'll have preventative surgery after what happened to my mum.  It was an absolute no-brainer for me.  For other people it might not have been if they were at a different life stage.  I'd had my kids, I didn't need my ovaries, I didn't need my womb, it was pretty clear cut.  Even then when I was thinking about the different treatment and when to have that surgery, I got most of my information from bumping into somebody in the ladies' toilets who has been through it before.  I think there's always going to be a need in terms of being able to have those conversations to take in all the information you do that and make some sort of informed decision.  What came out of that decision-making workshop and all the other things that we did about probabilities, it's all just a model.  It's a model of what might happen.  The thing is, all of these models, they're all wrong, they just help you maybe make a discussion or a decision that might be right.  You just never know.  I still don't know if the decisions I made were the right decisions either.  There needs to be that space for people to consider their options, you're never going to get the definitive answer.    Amanda: An important message there.  We talk a lot about using digital tools to be able to do things better at scale, better ways to give information, but I think what you're saying is we can't replace certain elements of human connection, we can't underestimate the value of that.  You made a really good point earlier as well about how so many of these decisions have uncertainty and it can be really difficult to navigate the complexities of a health system.  Perhaps even more challenging if you have struggles with health literacy or if you are an underserved group in some way or another.     Kelly, I think you mentioned that some of your research has also touched on developing information for underserved groups.  Can you tell us a bit more about that?  Kelly: We recognised that there are many underserved groups that are not represented in research, in literature, and applied for additional funding to do some specific targeted projects in the community.  There were a couple of examples I can mention.  One was inspired by colleagues at the Royal Marsden who made some videos about prostate screening and the had black men and their family members talking about this in a relaxed barber's shop setting.  Through reaching out into the community I was connected with Lee Townsend from Macmillan who's been making these barbershop videos around London for the last seven years.  He's focussed on a number of topics like mental health, vaccination and cancer.  We connected and it was really about making that connection in the community, him as a trusted leader, and having formed partnerships with some of the barbers who opened up their barbershops for filming these sessions and went way beyond that.    One of them has actually trained as a counsellor himself because he said men are coming for a haircut and actually they have a bald head, they don't need the haircut, they're coming actually for the chat.  Because it's benefitting their mental health and they felt able to open up about topics that they wouldn't talk about even at home with their family members or with their friends, such as symptoms of cancer, going for cancer screening or presenting for treatment if they were symptomatic.  It's really powerful.  We've actually filmed six videos with black and minority ethnicity patients, talking about their cancer experience and they've really both helped others by setting an example that it's okay to talk about these things.  Also, through the process an added benefit was helping themselves, so it was peer support.  When they came to the barbershop to film their stories, they didn't need to stay for the whole time but they did stay for the three hours.  They said afterwards how helpful it was just to hear others in a similar situation sharing their stories.  One of them told me he's got up on stage and shared his cancer journey and he's been going to these patient groups and talking when he didn't feel able to do that in the past.  It's been a great project and we're going to be adding the videos to the CanGene-CanVar patient decision aid website soon.  Another thing that we've done in the diet and lifestyle section of the website where it talks about things that people might do to lower their chances of getting cancer have partnered with Professor Ranjit Manchanda who had some colleagues in India and made some infographics that specifically depict patients of a South Asian heritage and the types of foods that they might be choosing to give examples of how they might for example try to get more fibre in their diet to lower the chances of getting bowel cancer or trying to eat more fruits and vegetables or drink less alcohol.  It shows images of Indian patients.  What people have told me in my research, my interviews, focus groups, is they tend to go and try to search for something that means something to them, so they're looking for someone like me.  One of the patients I filmed she said that she had breast cancer as a young black woman and she was only middle-aged women on the websites.  She thought why is this, do black women not get breast cancer or young women like me?  For her to share her story was very brave but also has the potential to help a lot of other people in the community.   Amanda: That's really powerful, so understanding those nuances in different cultures or communities or groups is just so crucial to really being able to also develop information or messages or provide care that's going to really reach those people where they are, I guess.  This has been a really fantastic conversation.  If we could end with a final question, it would be great to hear from your perspective just one thing that you'd like to see in the next five to ten years when it comes to care for inherited cancer susceptibility conditions.  Helen, let's start with you?  Helen: I think that in developing the guidelines one of the things that we've had to struggle or grapple with is a lack of evidence and the lack of the data that's available for some of these conditions.  I'm really hoping that over the next five to ten years that we will see much more data on cancer risks and outcomes of surveillance progress for people who have an inherited predisposition.  Then we can utilise that information to be able to share with patients to enable them to make best decisions about their care.  There's a number of initiatives that are currently underway thinking about how we might better collect data on patients with inherited cancer predisposition in the UK, through registries, so I am really hoping that we manage to get some useful data that we can then use in our discussions with patients going forward.  Amanda: Thank you.  Kelly?  Kelly: I think that over the next five to ten years as awareness and availability of genetic testing continues to increase, we know that there will be more and more families identified who have a higher genetic risk of getting certain cancers.  We can't replace that personalised counselling that takes place, face-to-face or sometimes telephone and video appointments with a healthcare profession.  So there are more resources needed for the NHS to deliver this.  To compliment that, the patient website decision aid that we have co-designed is one way to help.  What patients tell us they would like, access to a central trusted source of information that's up to date.  Importantly in genetics it's very fastmoving, there's a lot of research, guidelines are changing, and it's very crucial to have information that's correct and relevant for people, and also meaningful.  We can only do that by partnering together with patients and co-designing things rather than designing them and asking them afterwards if they're useful.  It's a partnership all the way through that we all benefit from.    As I said earlier, it's not a one-size-fits-all, decision-making is so personal and shared decision-making is recommended but we don't always have enough time in clinic to really address all of the issues that the patient might not have even thought about themselves.  Having something like a patient-facing resource website booklet that they can look at in their own time, prepare for their questions that they really want to focus on in clinic, it might help give them the confidence to bring something up that they might not have otherwise.  It's about a number of different ways of helping to support people.  We've identified that there are gaps in care that we could try to help address if we have more resource in future.  Those are my aspirations.  Thank you, Amanda.   Amanda: Thank you.  And Rochelle, to you?  Rochelle: I think for me I would like to have as many people as possible to understand or know about their genetic mutation status.  We know people don't even know about the fact that they may have a genetic mutation that may make them more susceptible to cancers, and we know that even then if you do can you get access to testing to know whether you've got it or not.  That is the most important thing.  My mum, if she'd known that some of this was related, if she'd had that awareness that breast and ovarian cancer in your family was related to potential genetic risk, maybe she would have pushed harder to get testing and maybe she wouldn't have been tested when it's too late.  In the end, all this knowledge and empowering people with knowledge, whether that be about empowering people with the knowledge that they may have a genetic mutation, there's a possibility of the genetic mutation, that these things are related and empowering people through the knowledge of knowing their genetic mutation status, all that is something that saves lives.  From my view, it undoubtedly probably has saved my life and so my hope for the future is that we can empower more people like me and we can save more lives.   Amanda: Thank you for our guests today Dr Helen Hansen, Rochelle Gold and Kelly Kohut.  If you enjoyed today's episode, we'd love your support.  Please subscribe to The G Word on your favourite podcast app and like, share and rate us wherever you listen.  I've been your host, Amanda Pichini.  This podcast was edited by Mark Kendrick at Ventoux Digital and produced by Naimah Callachand.  Thanks for listening.     

DIEP flap breast reconstruction most often requires surgical drains for post operative care. Patients often mention to me they are awkward, can become infected at the suture site where they are attached to the skin, and are cumbersome to hide under clothing after surgery when going out in public. My guest on this episode of the DiepCJourney podcast has been in communication with me over the past year in anticipation of his recently published paper, Are Surgical Drains Needed in DIEP Flap Surgery? The Drain-Free DIEP Flap Concept. Mr. Theo Nanidis, is a Consultant Plastic and Reconstructive surgeon with the NHS and private practice at The Royal Marsden. He graduated with distinctions from University College London Medical School in 2003 and completed his general surgical and higher plastic surgery training in London. Mr. Nanidis was awarded specialist fellowships at the Royal Marden and Queen Victoria Hospitals, where he spent two years specializing in microsurgery with a focus on breast reconstruction. He has a special interest in surgical innovation and was awarded The Life Sciences Entrepreneur of the Year Award from Cambridge University in 2013. His research interests include meta-analytical outcomes research, volumetric analysis of flaps and patient enhanced recovery pathways. He has published and presented his work nationally and internationally. We reference a paper by Ms. Anita Mohan, Modified aesthetic abdominoplasty approach in perforator free-flap breast reconstruction: Impact of drain free donor site on patient outcomes. This was the impetus for further work and the recently published paper by Mr. Nanidis. You can find his work on the following social media channels: LinkedIn: Theodore Nanidis Twitter: @drplas Instagram: drtheonanidis Facebook: Theo Nanidis Plastic Surgeon  

Half the UK population has chronic pain, making nurses increasingly likely to encounter patients living with it.So, what skills do nurses need to employ to understand how pain impacts an individual's life and assess what physical and mental health support they may need?This episode of the podcast explores the management of both acute and chronic pain with three experts in the field.Guest podcast host Martin Galligan, lecturer practitioner and programme lead of advanced clinical practice in cancer care at The Royal Marsden, interviews fellow pain specialists nurse consultants Felicia Cox and Karin Cannon.They discuss the importance of recognising pain as being what the individual describes it to be and the use of functional pain assessments to determine what the patient wants and needs, including psychological peace, to help manage their condition.The trio also talk about using motivational interviewing skills to support people with pain and acknowledging the sense of loss that patients may experience in coming to terms with chronic pain.For more episodes of the Nursing Standard podcast, visit rcni.com/podcast Hosted on Acast. See acast.com/privacy for more information.

Half the UK population has chronic pain, making nurses increasingly likely to encounter patients living with it.So, what skills do nurses need to employ to understand how pain impacts an individual's life and assess what physical and mental health support they may need?This episode of the podcast explores the management of both acute and chronic pain with three experts in the field.Guest podcast host Martin Galligan, lecturer practitioner and programme lead of advanced clinical practice in cancer care at The Royal Marsden, interviews fellow pain specialists nurse consultants Felicia Cox and Karin Cannon.They discuss the importance of recognising pain as being what the individual describes it to be and the use of functional pain assessments to determine what the patient wants and needs, including psychological peace, to help manage their condition.The trio also talk about using motivational interviewing skills to support people with pain and acknowledging the sense of loss that patients may experience in coming to terms with chronic pain.For more episodes of the Nursing Standard podcast, visit rcni.com/podcast Hosted on Acast. See acast.com/privacy for more information.

 **Introduction:** In this enlightening episode of *The Slimming Surgeon Podcast*, Dr. Kandace Kichler engages in a captivating conversation with Dr. Ashwin Soni, a UK and US-trained plastic and reconstructive surgeon, and the founder of The Soni Clinic (@thesoniclinic) in the UK. Together, they explore Dr. Soni's remarkable journey and insights into the world of plastic surgery.   **Episode Highlights:**   1. **A Global Education:**    Dr. Soni's extensive training at prestigious institutions, including Imperial College London, Cornell, Johns Hopkins, and The Royal Marsden, is a testament to his commitment to excellence.   2. **Surgical and Non-Surgical Expertise:**    Dr. Soni's practice encompasses both surgical and non-surgical procedures, providing a comprehensive range of options for his patients.   3. **Media Recognition:**    Dr. Soni's expertise has garnered recognition from renowned publications such as Vogue, Forbes, Allure, Cosmopolitan, and Harper's Bazaar, underscoring his impact on the field of plastic surgery.   4. **Exploring the Journey:**    Listeners gain insight into the personal and professional journey that led Dr. Soni to become a leading figure in plastic and reconstructive surgery.   5. **Operational Excellence:**    Dr. Soni's practice, The Soni Clinic, stands as a testament to his dedication to operational excellence and delivering exceptional patient care.   6. **Decision-Making in Procedures:**    The episode offers valuable insights into the decision-making process behind choosing between surgical and non-surgical treatments, helping patients make informed choices.   7. **Trends and Innovations:**    Dr. Soni shares his perspective on the evolving trends and innovations in the field of plastic surgery, providing listeners with a glimpse into the future of the discipline.   8. **Patient-Centric Approach:**    Dr. Soni's patient-centric philosophy is a driving force in his practice, ensuring that patient needs and expectations are met with care and precision.   9. **Media Recognition:**    The episode highlights Dr. Soni's remarkable presence in renowned publications, showcasing his expertise and contributions to the world of beauty and aesthetics.   **Conclusion:** Dr. Ashwin Soni's journey from top-tier global institutions to founding The Soni Clinic and his recognition in the media underscores his dedication to the field of plastic and reconstructive surgery. This episode offers listeners a unique opportunity to learn from a leading expert in the industry.   Stay tuned for more enriching conversations on health, wellness, and personal and professional growth, only on *The Slimming Surgeon Podcast*.   Disclaimer: The views, opinions, and information shared in this episode are solely those of the individuals involved and do not constitute professional medical or business advice.

This episode has the rather provocative title Listen to me, I'm dying! But what do we mean by that? Find out as host James Abbott discusses with our guests how much of a say do we really have over what happens when we die? Will our wishes be respected? And what about those emergency situations in case we change our minds over what happens next? Just like birthing plans at the start of life, shouldn't we all have a plan for how we exit this world so we can be as reconciled and at peace as possible? Alongside this we'll consider an interesting piece of research carried out in partnership with The Centre for the Art of Dying Well, to examine the impact of the digital world on death and grief. We're delighted to be joined by Professor Julia Riley, who spoke so eloquently on the subject of Diagnosing Dying in episode 25. Julia is a consultant in Palliative Medicine at the Royal Marsden and Royal Brompton NHS Trusts and a Visiting Professor at Imperial College London. She founded the initiative Coordinate My Care with the aim of providing patients with integrated, coordinated and quality care they would prefer, particularly at the end of life. And making his first appearance on the podcast is Dr Shaun Qureshi, a specialist in palliative medicine, who's been researching the medicalisation of dying and grief, in among other things, the post digital age. 

My guest this week is Daniel Marks, the co-founder of ‘Father & Son Day' - a charity set up to support The Royal Marsden Cancer Charity. Daniel had testicular cancer as a younger man, was treated at The Royal Marsden and thankfully he recovered. His father also had cancer and survived. ‘Father & Son Day' is about raising awareness of male cancers and celebrating the relationships between fathers (and father figures) and sons.To donate to ‘Father & Son Day' you can text MARSDEN to 70800 to donate £5 or visit https://www.royalmarsden.org/donate During our chat Daniel mentioned the following products:This Works - Vit. C Power Maskhttps://www.thisworks.com/products/morning-expert-vitamin-c-power-maskAesop - Shower Gelhttps://www.johnlewis.com/brand/aesop/shower-gel/_/N-1yzf0cvZno6cPhillip Kingsley - Itchy Scalp Shampoohttps://www.philipkingsley.co.uk/philip-kingsley-flaky-itchy-scalp-shampoo.htmlBarti Vyas - Face Oilhttps://www.bharti-vyas.com/product/harmonising-face-oil/Acqua di Parma - Beard Oilhttps://www.johnlewis.com/acqua-di-parma-barbiere-beard-serum-30ml/p4047477Dr Haushka - Bronze Concentratehttps://www.sephora.co.uk/p/Dr-Hauschka-Translucent-Bronzing-Tint-18mlGlossier - Cover Uphttps://uk.glossier.com/products/perfecting-skin-tintBare Minerals - Bronzing Powder Warmth https://www.sephora.co.uk/p/bareMinerals-Warmth-All-Over-Face-Colour-2gChanel - Sycamorehttps://www.johnlewis.com/chanel-sycomore-les-exclusifs-de-chanel-eau-de-parfum/p3943220Goutal - Eau D'Hadrienhttps://www.johnlewis.com/goutal-eau-dhadrien-eau-de-parfum/p109391430Acqua di Parma - Colonia C.L.U.B.https://www.johnlewis.com/acqua-di-parma-colonia-c-l-u-b-eau-de-cologne/p6066464?size=50ml111Skin - Face Maskhttps://www.libertylondon.com/uk/celestial-black-diamond-eye-mask-8-x-6ml-000730250.html#pos=5You can find Daniel on Instagram here: https://www.instagram.com/danielbmarks/ Hosted on Acast. See acast.com/privacy for more information.

On today's episode, meet Dr. Sanjay Popat. Dr. Popat has both a private and an NHS practice at The Royal Marsden. He is a Consultant Medical Oncologist at The Royal Marsden, Professor of Thoracic Oncology at the Institute of Cancer Research and is an internationally recognized expert in the treatment of lung cancer. Sanjay qualified from Guy's and St Thomas' Hospitals in 1994, completed general medical training at the Royal Brompton, and the Hammersmith Hospital, and medical oncology training at the Royal Marsden Hospital. He was awarded a PhD in Molecular Genetics in 2002. He's a strong advocate for patient education and support and is passionate about precision medicine.

On January 26, 2023, the US FDA granted approval of pembrolizumab, an anti-PD-1 antibody, as an adjuvant therapy for patients with resected NSCLC. In this episode of Lung Cancer Considered host Dr. Stephen Liu leads a discussion on this approval with two thoracic medical oncologists with extensive expertise in this space: Dr. Jamie Chaft, an Associate Attending at Memorial Sloan Kettering Cancer Center, where she is the Director of Early Stage Lung Cancer Research, chair of the adjuvant nivolumab trial within the ALCHEMIST program and heavily involved in perioperative systemic therapy studies. Dr. Mary O'Brien, Professor and Consultant Medical Oncologist at the Royal Marsden in Surrey, Head of the Lung Unit, and chair of the EORTC Lung Cancer Group. She was one of the investigators on the KEYNOTE 091 trial which provided key data that lead to this approval.

Karen and Sophie today are talking to a mouth cancer surgeon about what patients go through during their treatment. Professor Vinidh Paleri is a head and neck cancer surgeon at The Royal Marsden hospital in London where he sees both private and NHS patients, and he is also a Professor of Head and Neck Surgery at The Institute of Cancer Research. Vinidh is dedicated to helping patients with head and neck cancer and has the most experience in Transoral Robotic Surgery of any surgeon in the UK. In this interview, he sat down with us to answer some common questions about head and neck surgery, radiation treatment, and aftercare.Look out for our video series with Vin coming soon on our YouTube channel.You can learn more about Vin and his work at the Royal Marsden here.Learn more about our campaign by going to www.mouthcancer.org and following us on social media @mouthcancerorg and @oralhealthfoundation Hosted on Acast. See acast.com/privacy for more information.

In 2012, the 100,000 Genomes Project was announced, the same year we started this podcast!Back in 2015 we did an episode about the 100,000 Genomes Project so we're excited to revisit this massive project today with Dr. Julian Barwell, who is a clinical geneticist and has countless titles but today's most relevant one is the operational clinical lead of the 100,000 Genome project.After finishing his Clinical Genetics training (2001-2007) at Guy's, St George's and the Royal Marsden from the University of London; Dr. Barwell started as a consultant in Clinical Genetics in Leicester. He runs specialist clinics in inherited cancer susceptibility; non-alcoholic fatty liver disease and susceptibility to hepatitis, cirrhosis and hepatocellular carcinoma; Von Hipped Linda syndrome and Neurofibromatosis type 2. He has over 60 publications and helped coin the internationally known phrase, the 'Angelina Jolie effect' on referrals to inherited breast cancer clinics. He also developed the first YouTube channel for Clinical Genetics that has been viewed in over 100 countries and developed the Supporting Families with Cancer projects in association with the Genetics Education Centre (GENIE) at the University of Leicester. He is the clinical lead for the delivery of Paediatrics, Obstetrics & Gynaecology, Non-Malignant Haematology and Clinical Genetics national portfolio research studies (CRN) in the East Midlands. He is the rare disease lead for the 100,000 Genome Project in Leicester and the public and patient involvement clinical lead for the East of England Genomics Medicine Centre with the aim of reducing inequality of access to Genomic Medicine. He is the designer of the genome project eligibility criteria wheels for Health Education England and is on the Genomics England committee for patient involvement and access to genomics for black and minority ethnic groups. He is a national clinical advisor to the National Hereditary Breast Cancer Helpline and helped develop the award winning Prostaid male health App and is clinical lead of the United Against Prostate Cancer project, establishing tumour BRCA testing. He is joint clinical lead of the Paediatric and Genetics Clinical Research Facility at the Leicester Royal infirmary and is establishing a fragile X syndrome research group and patient self-navigation App project with the Genomic Medicine Service Alliance. He is a senior author of the newly commissioned book, Clinical Genetics and Genomics at a Glance as well as a children's book on DNA. On This Episode We Discuss:Ten years of the 100,000 Genomes Project (2012-2022)Advantages of using digital pedigrees tools such as the one developed by TrakGeneWhy it's important to have genomes from various ancestries representedImportance of utilizing digital pedigrees How the 100,000 Genome Project is going to change the role of genetic counselorsReclassifying variants as data is continuously being analyzedIf you want to learn more about what it's like to be a clinical geneticist, check out this article which follows Dr. Barwell through a day in the life, and you can find a list of Genomics England's publications here.To learn more about TrakGene, the pedigree drawing tool and clinical genetics database software company that we mentioned in this episode, you can head to their website or follow them on Twitter, Facebook, LinkedIn, and YouTube. You can also follow Dr. Barwell on Twitter and Facebook!Don't forget to enter our upcoming giveaway via social media next week for a lifetime subscription to TrakGene and a copy of “The Patient Will See You Now” by Dr. Eric Topol. You can also use code “DNATODAY” for a year free trial for TrakGene. Stay tuned for the next new episode of DNA Today on next Friday, November 4th, 2022 where we'll be defining quality genetic tests with Blueprint Genetics! In the meantime, you can binge over 205 other episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “DNA Today”. Episodes since 2021 are also recorded with video which you can watch on our YouTube channel. DNA Today is hosted and produced by Kira Dineen. Our social media lead is Corinne Merlino. Our video lead is Amanda Andreoli. See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, DNApodcast.com. Questions/inquiries can be sent to info@DNApodcast.com.

It's October and yes, we do pay homage and raise awareness regarding breast cancer. But not in the way we see in the en mass sense but in the NAKED way. I got NAKED with Mel Gabriel, a 37yr old breast cancer thriver and advocate and Dr Natalie Johnson an Oncoplastic Surgeon. Let's meet them... Mel is an entrepreneur, producer and writer living in Trinidad & Tobago. The founder and Chief Vision officer of Caribbean Lookbook- the premier catalogue for Caribbean fashion and style. Her journey with breast cancer she shares very candidly on social media, creating an atmosphere of transparency and education for anyone who consumes the content in her journey. She shares the ups and downs of being diagnosed with breast cancer giving hope that life has to be lived...to the fullest, even with breast cancer and a double mastectomy before the age of 40...WHAT A BADASS! It is no surprise Mel shares with us on NAKED, because that's exactly what we're about....keeping it real!!! Dr Natalie Johnson hails from Trinidad & Tobago and has been resident in the UK since 2002. A member of the Black Surgeons Network n the UK, Natalie continues to extend her research (an already very broad scope she has) into the breast and oncoplastic reconstructive surgery before her completion of her Fellowship of the Royal College of Surgeons. She is currently working at the Royal Marsden NHS Trust, a hospital dedicated to the treatment of cancer. With funding from the Royal Marsden cancer charity in collaboration with Nubian Skin, the softies in diverse skin tones initiative was born with the help of her colleague Sarah Adomah. She hopes to get this prosthesis available to all patients of colour who require it as part of their patient care. So much was shared and learned from all angles in this conversation and I look forward to hearing from you, your own experiences and thoughts. Thanks for engaging and remember to LIKE. COMMENT. SHARE. SUBSCRIBE. Thankies!!!!

Treatment for malignant pleural mesothelioma has undergone dramatic shifts in the past few years. To discuss these changes and the research behind them, Lung Cancer Considered Host Dr. Stephen Liu welcomes Dr. Sanjay Popat and Dr. Melina Marmarelis. Dr. Popat is a Consultant Thoracic Medical Oncologist at The Royal Marsden and Professor of Thoracic Oncology at the Institute of Cancer Research, in London, England, and Chair of the British Thoracic Oncology Group. He is also on the Board of Directors for the Mesothelioma Applied Research Foundation. Dr. Marmarelis is an Assistant Professor of Medicine at the Hospital of the University of Pennsylvania and the Medical Director of the Penn Mesothelioma and Pleural Program.

A huge percentage of people who have cancer and cancer treatment experience 'cancer-related cognitive impairment' - aka 'chemo brain' or 'brain fog'. In this episode, we chat to occupational therapist Tamsin Longley and research nurse Sarah Stapleton from the Royal Marsden in London, two women on a mission to help people affected by brain fog. 

June 1, 2022 RJ podcast: Three Chippy Topics in Prostate Cancer. In this month's podcast, two Genitourinary section editors, Dr. Alison Tree, consultant clinical oncologist at The Royal Marsden and Honorary Faculty at the Institute of Cancer Research, and Dr. Daniel Spratt, Chairman and Professor of Radiation Oncology at University Hospitals Seidman Cancer Center and Case Western Reserve University, join Editor-in-Chief Dr. Sue Yom to review three articles addressing cutting-edge issues in prostate cancer. The group discusses the new oral gonadotropin-releasing hormone antagonist relugolix ("An Expert Review on the Combination of Relugolix With Definitive Radiation Therapy for Prostate Cancer" at https://www.redjournal.org/article/S0360-3016(21)03240-5/fulltext), the future of MRI-based radiation dose escalation to the dominant intraprostatic lesion ("SABR for High-Risk Prostate Cancer - A Prospective Multilevel MRI-Based Dose Escalation Trial" at https://www.redjournal.org/article/S0360-3016(21)03047-9/fulltext), and an analysis from the United Kingdom's CHHiP trial comparing disease outcomes and sexual function among patients receiving bicalutamide versus luteinizing hormone-releasing hormone analogues ("Nonrandomized Comparison of Efficacy and Side Effects of Bicalutamide Compared With Luteinizing Hormone-Releasing Hormone (LHRH) Analogs in Combination With Radiation Therapy in the CHHiP Trial" at https://www.redjournal.org/article/S0360-3016(21)03433-7/fulltext).

In this episode, Flavilla is joined by William Wells. They discuss how can satellite data and machine learning measure sustainability in farming and help to optimise food production.Will founded Hummingbird Technologies in January 2016, where the business spent its first year developing Machine Learning algorithms at the Imperial College technology incubator. Prior to this, Will spent 10 years in the Finance and Investment sector. This included M&A and other special advisory roles at Citigroup and Lincoln International, as well as investment management at the successful multi-billion dollar Highclere global equity fund, where he was also a Partner. Will grew up on a farm and is a keen sportsman. He holds an MBA from INSEAD Business School and a First Class MA Honours degree in English Literature from the University of Edinburgh. Will sits on the Board of a Royal Marsden cancer charity and Math Engine plc, a UK public investment fund.  To connect with William, CLICK HERETo visit Hummingbird Technologies website, CLICK HEREJoin Tech Brains Talk mailing list for more perks, CLICK HERETo find out more about 3 Colours Rule Agency, CLICK HERE

Today you're hearing from Dr. Naureen Starling. She is a consultant medical oncologist at The Royal Marsden in London. She specialises in different gut cancers, including Pancreatic Cancer. She's also a trustee of Pancreatic Cancer UK. In this episode she takes us back to basics as she explains more about the pancreas, what it is, where it is and what it does. You can follow these hashtags #Sethslegacy and #30PRPodcasts as well as #ShineASpotlight4Seth and #Sparkle4Seth You can find out more about Purple Rainbow herehttps://purplerainbow.co.uk/ ( https://purplerainbow.co.uk/) Music Credithttps://www.purple-planet.com/ ( Purple Planet Studios) DISCLAIMER: All views, information or opinions expressed in this podcast series are solely my own and those of individuals interviewed and do not necessarily represent the views and opinions of Pancreatic Cancer UK , Pancreatic Cancer Action, Pancreatic Cancer Research Fund And The Elizabeth Coteman Fund  The charities and their employees are not responsible for and do not verify the accuracy of any of the information contained in the podcast series. The primary purpose of this podcast series is to inform, but it does not constitute medical or other professional advice or services.

Sat down with Reija Kime who is womb cancer survivor with Lynch Syndrome who is Cycling for Cancer across Europe.   Reija is giving back for her care at Royal Marsden before going back to her mother country Finland.  I learned that Lynch Syndrome has colors.  Who knew?

A conversation with Dr. Hedy Kindler of the University of Chicago Medicine, and Dr. Sanjay Popat of the Royal Marsden in the UK, about current trends and advances in mesothelioma treatment with a special focus on immunotherapy, chemotherapy, and various combinations thereof. Moderated by Dr. Marjorie G. Zauderer of Memorial Sloan Kettering Cancer Center and chair of the board of directors of the Mesothelioma Applied Research Foundation. More information about MesoTV is available at www.curemeso.org/mesotv. More information about the Mesothelioma Applied Research Foundation can be found at www.curemeso.org.

Miki is a powerhouse of a woman. Her path to become a Reiki Master and Craniosacral Therapist was as a result of both her children becoming chronically ill. She not only survived every mother's worst nightmare but came out of it stronger and is a true inspiration and warrior mum. Miki talks through her journey and how her then 18 month old daughter was diagnosed with stage 4 cancer and was given 20 percent chance of survival. Conventional medical treatment at the Royal Marsden hospital was complemented with good Nutrition, Homeopathy, Reiki and Craniosacral therapy and she is now a very healthy and happy 17 year old girl who is cancer free and enjoys life to the full. Miki's son was diagnosed with autism at 18 months and had chronic gut dysfunction, seizures and severe allergic reactions to most foods. His immune system was severely compromised and he often only slept 5 hours a night and waking up screaming in pain. He would spin in circles and flapped for hours and developed OCD, ODD and PANDAS. Thanks mainly to Homeopathy, Reiki, Craniosacral therapy and Son Rise he is now a very loving, happy and sociable boy who is still cognitively and verbally delayed but making steady progress at school. He can eat all foods, is allergy free and on the path to recovery. His gut is healing and he sleeps 10-12 hours a night. Miki's children's health problems are the reason why she studied to become a Reiki Master and Craniosacral therapist. Both have improved all their lives in ways Miki could never have imagined possible. It was a pleasure to chat to Miki and her journey to her life changing career. https://mikiettorehealing.com/ Music: Buddha by Kontekst https://soundcloud.com/kontekstmusic

In this episode, Neil and Ian are joined by Mavis Nye and Paul Cook representing ActionMeso. #ActionMeso is a campaign that brings together the diverse mesothelioma community with a single voice. It is the first time that so many patient support groups and charities have joined forces to raise awareness of mesothelioma. Their aim is also to get the rest of the mesothelioma community on board including patients, carers, healthcare & legal professionals together with the asbestos removal firms and the construction industry. Paul Cook - Bio "In 2017, I was diagnosed with pleural mesothelioma. At that time I was running a business, was fairly active nut then got pneumonia and my lung collapsed. I was then informed that I had terminal cancer. During various treatments including chemotherapy, surgery to remove the lining of my lung and radiotherapy I decided that, if I made it through, I would start a charity dedicated to find raising funds for research into a cure or at least maintenance of this terrible illness. Since starting Erase Meso along with my wife, Jill and the other Trustees we have come into contact with some amazing people including mesowarriors, carers, supporters or people within the medical profession. We believe we can make a real difference as mesothelioma research is dreadfully underfunded. My best moment so far was cycling over 900 miles across the UK last year. The support was incredible and so many people helped me get there. In 2020, I am excited that we will be making our first grant which will be the start of many!" https://www.erasemeso.org/ Mavis Nye - Bio “My journey with Mesothelioma began as so many Patients find with the day I couldn’t breathe. I was rushed to A&E and they had found a bed for me,where they drained 7ltrs of fluid. So my lung had collapsed, and my diaphragm had bent. They found Mesothelioma cells when testing the fluid. And I was given a 3 months Prodgnosis. After going to Guys hospital, where I had a pleurodesis, I came home with a drain. The Bi-op that had been carried out at the same time confirmed the Diagnosis. 4 Years of Chemotherapy then followed with shrinkage then regrowth 4 times within those years. I became too toxic and I was told there was no more treatment. I had already made it known I was interested in any trial and Immunotherapy was just being investigated. MSD had this trial at the Royal Marsden and I was referred there on my request as Dean Fennel thought it would suit me. Prof De Bono agreed, and I was one of 3 patients to start MK3475-28. I had complete response. It was only because I had Sepsis right at the end of the 2 year trial that I didn’t get that result included in the final figures in  time so I'm under the heading of ongoing. That was disappointing. I had 2 years freedom but then last March new growth showed. The old Meso was still in remission though. The new growth was bi-oped and it was found it was full of PDL1 whereas I only had 1% before. I became the first patients in the world to re-challenge the drug. Within 4 infusions it shrunk 14% and then stopped. It is growing again very slowly, not enough to bi-op yet. The Royal Marsden have matched my DNA to a drug that they can use to boost Pembro and maybe kick it in to work again. That is in the future. I keep busy raising awareness of Asbestos and the dangers to Health and Safety today as the tradesmen work where the asbestos is hiding and the awareness of how important it is to use the right mask and to have Face/Fit training. Also the Awareness of Mesothelioma and how we need to talk to each other. I run the Social Media as well as My Charity The Mavis Nye Foundation.” https://www.mavisnyefoundation.com/

Recently awarded an MBE due to his work at London Nightingale, Jatinder Harchowal shares his story of being part of that team and at the same time contracting Covid-19. His passion for patients shines through as he discusses his leadership style and the impact of building high performing teams.Brought to you by Clarity Leadership - Thoughts, ideas and inspiration for businesses:https://www.clarityleadership.co.uk See acast.com/privacy for privacy and opt-out information.

Where to find Milica:Instagram: @milica_kastner, @twostagefoursTwitter: @milica_kastnerFor more information on the topics discussed in this episode please visit:USA: The American Cancer Society: www.cancer.orgUK: Macmillan Cancer Support: www.macmillan.org.uk

Chris and Lizzie discuss the Cambridge’s visit to London.Prince William followed in his mother’s footsteps to lay a foundation stone at The Royal Marsden hospital, while Kate helped launch the Hold Still photographic exhibition on display across the UK.We hear from Sami Ayad who spoke to the Duchess after a photo of him made the final select few for the lockdown project.The Duke and Duchess also marked a year on from their visit to Pakistan. They caught up with the schoolchildren they met on their travels over a virtual game of Pictionary.Chris and Lizzie also discuss Prince Harry and Meghan’s TIME talk about internet safety and the launch of the Archewell foundation website - but what does the name mean?New episodes of The Royal Rota are released every Friday.You can also watch The Royal Rota on our YouTube channel - subscribe to ITV News' YouTube channel to be notified about new episodes.For more royal news, like the ITV News Royals Facebook page. Our royal team are on Instagram, too.

This is the special Marathon Edition of the Women's Running podcast. On Sunday 4th October Esther, along with 43,000 others, ran the virtual London Marathon. Two women who also ran it were Deborah James and Emma Campbell, both of whom have been on the podcast before. This time we wanted to talk to them both about our experiences running our virtual races. They ran together, supporting each other every step of every mile, while raising money for their beloved Royal Marsden, a hospital that has supported and cared for them so much. You can still donate to their justgiving pages, so please do so with the links below. They talk with me here about the importance of their chosen charity, and also Deb's history with the London Marathon, the power of giant Wotsits, and the sheer joy of our virtual races. We also discuss our next racing highlight – the Vitality 10K, which you can sign up to as well before 23rd October. Again the link is below. Plus there's some proper, tangible advice on running your next marathon right here, and it involves pants.Sign up to the virtual Vitality 10K hereDonate to Deb hereDonate to Em hereSupport the show (https://www.patreon.com/bePatron?u=67575412)

This is the special Marathon Edition of the Women's Running podcast. On Sunday 4th October Esther, along with 43,000 others, ran the virtual London Marathon. Two women who also ran it were Deborah James and Emma Campbell, both of whom have been on the podcast before. This time we wanted to talk to them both about our experiences running our virtual races. They ran together, supporting each other every step of every mile, while raising money for their beloved Royal Marsden, a hospital that has supported and cared for them so much. You can still donate to their justgiving pages, so please do so with the links below. They talk with me here about the importance of their chosen charity, and also Deb's history with the London Marathon, the power of giant Wotsits, and the sheer joy of our virtual races. We also discuss our next racing highlight – the Vitality 10K, which you can sign up to as well before 23rd October. Again the link is below. Plus there's some proper, tangible advice on running your next marathon right here, and it involves pants.Sign up to the virtual Vitality 10K hereDonate to Deb hereDonate to Em hereSupport the show (https://www.patreon.com/bePatron?u=67575412) Get bonus content on Patreon Hosted on Acast. See acast.com/privacy for more information.

In this episode, I talk with Professor Justin Stebbing. He is a professor in the Faculty of Medicine at Imperial college London. He initially trained at Oxford, before having a residency at the Johns Hopkins Hospital in the US, then returned to the UK to work at the Royal Marsden, Barts and now Imperial. He specializes in cancers and immunotherapies.  He has an extensive research background having published over 550 peer-reviewed papers. He recently published in the Lancet new research on using AI to find drugs to treat COVID-19.  In this podcast we discuss: Current vaccine trials Absence of COVID-19 reinfections Why is vaccine development faster than before Low mutability of COVID-19 Symptoms of COVID-19 Why are minority groups experiencing higher infection rates Why are elderly being affected the most Views on the Sweden approach Why is the US death rate not higher Policy recommendation

Bryn Thomas is the Centre Head for Maggie's at The Royal Marsden, who provide free cancer support and information at their centres across the UK and online. Today he talks to Jill Bennett about their work, how COVID 19 has affected people living with cancer and how Maggie's is funded. www.maggies.org

Jack talks to Lisa Emery, CIO at Royal Marsden NHS Foundation Trust and Chair of the London CIO Council. Lisa takes us from her first job filling jam doughnuts in a bakers (she's been put off doughnuts for life) through to following in her mum's footsteps as a biomedical scientist and then to CIO of an NHS Trust. She discusses her journey through the healthcare sector, her approach to leadership and how her outlook as been shaped by leaders who have inspired her throughout her career. Lisa discusses her fierce passion for ensuring women get opportunities in STEM careers as well as leadership ones - harking back to her O Level days when her parents had to visit the school to assure teachers she would succeed in taking all three sciences "even though she was a girl". This episode is sponsored by CommonTime. CommonTime provide secure messaging and mobility solutions to healthcare, delivering practical innovations to meet the challenges in today's NHS.

London-based designer Ab Rogers tells us about his passion for colour, why design and architecture should be fun, and how to cook with toddlers. Ab Rogers Design, London/Melbourne, is an architecture and design practice that has created some of the most imaginative and colourful projects around the world including Comme des Garçons Paris, The Rainbow House, Pizza Express, Wonderfruit Festival Thailand, Maggie’s at The Royal Marsden, as well as numerous art and cultural exhibitions.www.abrogers.com @abrogersdesign @ab.rogersSupport the show (https://www.patreon.com/betweentwocurators)

Today we are joined by three giants in the world of stereotactic-assisted body radiotherapy (SBRT), to discuss the use of SBRT in various stages of prostate cancer. Associate Professor Shankar Siva from Peter MacCallum Cancer Centre joins us in the studio, along with Dr Alison Tree from the Royal Marsden in London, and Dr Piet Ost from Ghent. Your usual hosts are Professor Declan Murphy and Dr Renu Eapen. 

Dr. Hayes interviews Dr. Trevor Powles his involvement with translational medicine in the UK and early bisphosphonate. Conflict of Interest: Dr. Powles has not reported any conflicts of interest to ASCO.   TRANSCRIPT The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Welcome to JCO's Cancer Stories-- The Art of Oncology brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all the shows, including this one, at podcast.asco.org. Welcome to Cancer Stories. I'm Dr. Daniel Hayes. I'm a medical oncologist, and I'm a translational researcher at the University of Michigan Rogel Cancer Center in Ann Arbor. And I'm also the past president of the American Society of Clinical Oncology. Today I am privileged to be your host for a series of podcast interviews with the founders of our field-- today in particular Dr. Trevor Powles. Over the last 40 years, I've been fortunate to have been trained, mentored, and inspired by many of these pioneers. It's my hope that through these conversations all of us can be equally inspired by gaining an appreciation of the courage, the vision, and frankly the scientific understanding that these men and women who established the field of clinical cancer care over the last seven decades. By understanding how we got to the present and what we now consider, quote, "normal," end of quote. I hate using quotes, but in oncology I think we can also imagine our work together towards a better future for our patients and their families during and after cancer treatment. As I've noted today, I'm really honored to have as my guest on this podcast Professor Trevor Powles. He's really generally considered one of the true pioneers in breast oncology. Dr. Powles was raised in London, where he went to medical school. He trained in medicine and surgery at St. Bartholomew's Hospital and associated affiliates, graduating from medical school in 1964. He went on to obtain a PhD at the Institute of Cancer Research. He directed his thesis towards hypoglycemia and bone metastasis. Following his PhD, he then completed specialist training in medical oncology at the Royal Marsden and further pursued training in endocrinology with Professor Philip Bundy, [? who was ?] then Chief of endocrinology at Yale before moving to the UK. Dr. Powles remained at the Royal Marsden hospital during the bulk of his distinguished medical career, first as head of the Marsden breast cancer unit, and ultimately is the founding chairman of the Committee for Clinical Research for the entire Royal Marsden. After he retired-- which again requires [INAUDIBLE]-- at the age of 65, Doctor Powles has served on staff at the Cancer Center at London Parkside. Dr. Powles has authored hundreds of peer reviewed papers. He's mentor of many of the leaders in breast college around the world, which we will discuss in a second. And he's really won too many awards and honors from me to list here, but they include the coveted William McGuire Award presented annually at the San Antonio Breast Cancer Symposium-- and by the way, so have two of his mentees, Professors Mitch Dowsett and Ian Smith. And he's also won the Nancy Brinker Award. Many of you know Miss Brinker founded the Komen for the Cure Foundation. And perhaps what is perplexing to those of us in the colonies, in 2002 he and his twin brother Ray were named Commanders of the Most Excellent Order of the British Empire, or CBE for short-- which of course is one of the highest honors one can obtain in the UK-- for their work in breast in Trevor's case, and haematologic cancers in Ray's case. Trevor, I know that a lot of your work also was done with a variety of other contributors, including Dr. John Kanis, Dr. Eugene McCloskey, and of course Sandy Patterson [? period. ?] You've always been quite generous in pointing out that they had a lot to do with your own contributions, and we appreciate that as well. Dr. Powles, welcome to our program. Thank you very much, and thank you for those kind words. Yeah. Actually, I interviewed someone a few weeks ago, and he said, "Geez, that sounded like my mother wrote that." [LAUGHTER] I have a number of questions for you, and I want to start out-- your research and your background was really in endocrinology of the 1960s. And that was a particularly exciting time for endocrinology with the discovery of the hormones not more than 20 years before that, and then the increasing knowledge of understanding of [? the ?] peptides steroid hormone receptors. What made you veer off from that field into oncology in general and breast cancer specifically? When I was working at the Hammersmith Hospital doing my endocrinology [INAUDIBLE] endocrinology there. And one of the conditions we would be looking at would be hypercalcemia with hyperparathyroidism. And hypercalcemia was occurring very commonly in the breast cancer patients in the oncology and the radiotherapy department. [? And ?] to begin with, we thought this would just be another paraendocrine-type syndrome, and that was the thing that really fired my interest. From there, I then wanted to do my PhD to look more into what was causing the hypercalcemia with breast cancer, and that started the whole path of finding out about bone metastases, what they were doing, how they were causing the hypercalcemia, and the path just continued and continued. Most of your work-- I'm going to get to some of the other things you've done-- has been endocrine therapy, endocrine processes, and the bone metastasis, which is really endocrinology. In the United States about that time, most of the excitement in the 60s was around chemotherapy. Was it difficult for you to stick with the endocrine approach? No, it wasn't really. When I first started, all of in the endocrine treatment was ablative treatment. And I knew that from when I was doing my endocrinology is that the hypophysectomy, adrenalectomy, oophorectomy, those were the early days for chemotherapy at using combination chemotherapy and metastatic disease. [INAUDIBLE] and endocrine therapies were far better treatments from the chemotherapy. And although I was doing chemotherapy because we started with single agents then combination treatments-- and there was a lot of chemotherapy going on at that time at the milestone for haematological cancers, lymphoma, teratomas, et cetera-- I was able to do that, but I really focused on the endocrine side. And coming back to the hypercalcemia, the one thing that really impressed me was when I was originally doing my endocrinology was that rapid response you could get to the hypercalcemia by ablative endocrine therapy for oophorectomy, or adrenalectomy, or hypophysectomy. And that was really the thing that started all of the research I did in bone. It started on my PhD with in vitro work. We set up bone assays, I went to Cambridge to [INAUDIBLE] very famous scientist Cambridge to teach us how to do the bone assays for in vitro bone assays. We also set up the animal model with breast cancer. We were able to show that breast cancers could cause bone breakdown and osteolysis in vitro. We could find that we could block that by using drugs like aspirin, and that got us very interested in cross [? demandings. ?] We could then go into the animal experiments. And when we had a rat model using breast cancer that we knew from our assays caused bone breakdown in vitro, and when we did that in the animals by injecting into the aorta we could get bone metastases [? and ?] soft tissue tumor. When we gave aspirin, we could completely prevent the bone metastases-- quite dramatic experiments. And that was what really fired me into getting into the oncology, getting into the endocrine treatment in oncology because of my background in endocrinology. And that has stayed ever since. So what was the timing there? This is the late 60s? My PhD was 1970 to '73. I was at the Hammersmith from '67 to '69, and then I went to [? Barts ?] to endocrinology, and then I came back and then with Bondy in the Marsden, and then I got on the staff of the Marsden as a senior lecturer in 1975. So what you just described to me sounds like translational science. That word wasn't coined until probably 20 years later. Was it unique where you were to be taking things from the lab straight out to the clinic? And where there obstacles to doing that? No, there weren't. The thing that was good about that was we were doing the laboratory work based on what we'd seen, what I'd seen in the endocrinology with the hypercalcemia and the bone metastases, and responding to endocrine therapy. I then was in the PhD, doing the PhD, and then I was able to translate that into the clinic once I then became a consultant. So the main work I was doing when I was first a consultant, the research work, was actually looking at hypercalcemia bone metastases in patients. We had a surprise because when we took the aspirin into patients, we could see no effect at all even though we'd had very dramatic effects in vitro and in vivo. And it was only when the bisphosphonates came through that we were able to then use those, because at this stage we knew it was working on osteoclasts. And it was only when we started to get the bisphosphonates that we really got into the dimension of first of all, being able to treat the hypercalcemia, then being able to switch off the bone metastases, bone pain, and bone fractures with bisphosphonates. And then take it into the adjuvant, I was then able to take it into the adjuvant scene and set up the first adjuvant bisphosphonate trial. So I'd gone right from in vitro, I continued the path right the way through to clinical work. And then what happened was that if we did the bisphosphonate trial and we got the result of just like that had happened in the rats-- it stopped the development of bone metastases and it stopped the hypercalcemia in the rats, but didn't affect the soft tissue. So in the humans, we had exactly the same result where we were able to reduce bone metastases, not have an impact on soft tissue or other disease, and improve mortality. And so we've gone right the way through. It's a story that's extraordinary from my point of view, because I was able to follow the whole path all the way through. And you're absolutely right. That is a really good example of translational research where you hang in there until you get the answer. What's the history behind transferring the bisphosphonates from prevention of osteoporosis in cancer? Now they're widely used as well as denosumab. In fact, it's malpractice not to use them in a patient with bone metastasis. How did you make that leap where you're standing next to somebody who was treating osteoporosis, and you said, "I wonder if that should work?" And how did you get hold of the drug? There's got to be a history behind it. Well, we were looking. We were looking for [? anti-osteodiscitis ?] agents [INAUDIBLE] the aspirin didn't work but [INAUDIBLE] worked so we knew for no reasons at all that it would prevent, stop hypercalcemia. And so we were going down that path, and two really important people in the way the path was going. One was Herbie Fleisch, and Herbie Fleisch [? had ?] suddenly produced bisphosphonates. It was a terrific story if anybody was interested in bone, because it was an agent that clearly was working on osteoclasts, and that was the target we were after. We knew at that stage that the cancer cells had to activate osteoclasts in order to cause the bone breakdown and develop in bone. And the second person who was key was Craig Mundie, who again I met. And I went over to the Boston Dental Hospital several times, and I met Craig and the others there, and that was linking up with being able to see the story that they were developing where tumor cells were activating osteoclasts that were then causing bone breakdown that was then producing growth factors to activate the cancer. So it became a really preferential site for bone metastases to develop because of the interaction between the cancer cells and the osteoclasts. So then there's Herbie Fleisch in Switzerland. I had a few skis with him. He was a very good skiier. But the spin off was that bisphosphonates were going to be the thing that we really [INAUDIBLE] to be looking at. And then we tried four different bisphosphonates. Five foot was a guy in Amsterdam who had APD that was actually the forerunner for [INAUDIBLE]. And the one that worked best for us was clodronate, which we got originally from Finland. And we set up the bone trials. We had to go through three stages. We had to-- first of all, before we could use adjuvant, we had to show that it worked in metastatic bone disease. And it did. It reduced what's called skeletal related events-- that's fracture, hypercalcemia, pain-- requirements of radiotherapy. We then did a trial for phase 3 trial of using clodronate for patients who had metastatic disease but who didn't have bone metastases. And we could reduce the risk of them getting bone metastases. And then we had the justification for doing the-- So let me interrupt you for a minute. Now you're about 1983 or '4 I think when that was probably? Is that right? It was-- yes, it would be. With the adjuvant trial, we would have started in '86. I think. That's the window of time. And then in that trial, we didn't get the results from that until I think it was 1997 when we did the first analysis, and that we were able to then show in that randomized-- it was placebo controlled as well-- we were able to show a reduction in bone metastases and improved survival. And then we did a subsequent analysis in 2006. So we've got longer term data. Back then where other bisphosphonate trials were going on, adjuvant bisphosphonate trails going on, and then we had the meta analysis in 2015, Oxford meta analysis, which I was involved with Rob Coleman. And we did the analysis there, which confirmed that we could reduce bone metastases and improve survival with adjuvant bisphosphonates. So the story that starts from a test tube, so to speak. Oh, there's one other very interesting experiment we [INAUDIBLE] that's never been repeated. Right at the beginning, we were able to show that doing co-cultures-- you're reminding me of things now-- doing co-cultures of the bone assay with human breast tumors I'd get from the Marsden while I was at the institute. We'd have fresh human tumors, and we would do a co-culture and some of them could cause the complete breakdown of the bone assay, and others would not have osteoporosis. And we did a follow up of those patients-- it was only about 30 patients, I think-- and we did a follow up of those patients, and those who had the most bone breakdown in vitro [? with ?] [? those ?] patients who were then going to get the bone metastases. That was a real incentive to show that link that we were getting. So we knew something was going on there. And that experiment was going on in 1971. And in 2015 with the meta analysis of bone mets and mortality. So that's a long story. That's the story. Let me say that this entire story reiterates the phrase that, "On the shoulders of giants we all stand." You look at the number of people you've laid out who led to this story, which is still ongoing. It's actually fascinating. I want to return just a minute to your work with endocrine therapy of breast cancer and your work with tamoxifen. But first of all, a lot of young people listen to this. 'Cause I came in the field just as surgical ablation of many of the origins of estrogen was going away. Can you talk about what it was like to take care of the patients who were having hypophysectomies and adrenalectomies and oopherectomies? I recall thinking, "I'm an endocrinologist here. I'm not a medical oncologist," as a first year fellow taking care of Addison's disease and other things. There are two things about ablative endocrine therapy. The first was that the responses could be very dramatic, and it was quite a high response rate. There was something [INAUDIBLE]-- don't forget we weren't basing it on ER. ER came later, and then [INAUDIBLE]. Even not based on ER, we were getting 30% to 40% response rates, particularly in bone. The second thing is the management of the patients. The hypophysectomies were relatively easy, because I'd already got experience of patients who got pituitary failure from my endocrinology, and that's much it easier to manage. But the adrenalectomies are much more difficult because you can get very acute glucocorticoid symptoms if you're not getting cortisol, whereas in hypophysectomies it's a relatively slow process. And they were much more difficult to look after. But the thing that was important about it was the fact that although we were doing it, these patients were getting hypercalcemia [INAUDIBLE]. You could have a patient who was hypercalcemia, you do ablative surgery, within 48 hours the calcium is back to normal. In fact, it will go hypoglycemic sometimes on bone hungry [INAUDIBLE] thing. And from a clinical point of view, it was some of the best responses we ever saw even up to this time. Now one of the things that came out of that was that we had one patient-- I can say a name because he's long since dead and [INAUDIBLE] anyway-- her name was Mrs. Pottinger. It's engraved in my mind forever. And she had bone metastases, and she was not particularly well and also had some heart problem. And she was due to have adrenalectomy, and she wasn't well enough for adrenalectomy. And so what I did is I'd used [INAUDIBLE] when I was at the Hammersmith as part of treating Cushing's disease. And so I'd already knew about medical treatment for-- so I then decided that we would do-- and I think it must have been the first patient. I had to get permission from [INAUDIBLE], and I still got the letter I wrote to the medical director of [INAUDIBLE] then saying could we use [INAUDIBLE]. So what we do is the basis was in order to get her well enough to have her adrenalectomy, and she did exactly the same as she would have done if we'd done adrenalectomy. Within 24 to 48 hours, she's getting better, the pain's going, the calcium's down. So she then refused to have an adrenalectomy. There's no way she is going to have it. She said, "No I'll continue with the [INAUDIBLE]." And she continued on [INAUDIBLE] for over a year before she died. And that started a whole new thing. [? Ian ?] [? Smith ?] was my registrar at the time. And so we decided we'd do a phase 2 trial. We did a Phase 2 trial of [INAUDIBLE] on the understanding we were doing a medical adrenalectomy. And that started the whole story that we were doing using [INAUDIBLE], because a [INAUDIBLE] came over, I had various other people come, and what we found was the story was. It wasn't the medical adrenalectomy by blocking postmenopausal estrogen. And then we went down the pathway of doing various, about three or four different aromatase inhibitors with Mitch doing all of endocrinology. It's a wonderful time. We had Adrian Harris, Charlie [INAUDIBLE]-- [COUGHING]. [INAUDIBLE]. [INTERPOSING VOICES] That's a parade of stars. Were you talking across the Atlantic a lot during that time with Dick [? Stanton, ?] and Angela Brody, and the other two who were also-- Yes. Angela Brody was the one who got us a source for [INAUDIBLE]. That was the phase 2. Charlie led on that on the phase 2. That was Angela getting us to do that and linked him with Mitch. And Dick Stanton, yes it was a lot of collaborative work with Donald MacDonald. And a lot of the endocrinologists I knew. So that was how that whole story rolled. That's an amazing library. Let me take you back now to your childhood. I know you and your identical twin, Ray-- by the way for the listeners, if you Google either Trevor or Ray Powles, you'll see pictures of the two of them standing together. And I challenge you to tell who's who. [LAUGHTER] Anyway-- Well I could. I could tell the difference. Yeah I know you can tell the difference. I know that you were both young boys in London during World War II. Tell me about the experience then, and how your mother moved you. Obviously, we were very young. My father was in the Navy abroad, so my mother was alone and was looking after my older brother David, who was four or five years older than us. And I can remember the bombing. I can remember quite a lot about it, surprisingly. We were evacuated up into the north of England 1943, 1944, something like that. And we were there for I think something like six months. And it was an incredible story. I went back to see-- I hadn't been back-- I went back to see-- I was up in the north of England, and I suddenly thought I'll go over. We were at a place called Stockton. And so I was five when we left-- four, four years old when we left. And I had no idea. I knew it was Stockton, and I knew the name of the house was the Priory, and I had a faint recollection of the door. And then I went up to Stockton, and I found the house we were in. And I knocked on the door, and it was a major-- a colonel-- Colonel Brown and his sister who lived there. And the sister was still alive, and she must have been about 90. [INAUDIBLE]. And she looked at me and she said, "You're one of the twins." [LAUGHTER] So we had a chat. [INTERPOSING VOICES] At the time, did you think of this as being frightening, or was it just a great adventure for a young boy? Yeah, I wasn't unaware of danger. My house was bombed down the road flattened and presumably a lot of people died, but I was unaware of danger as such. We had a shelter-- it's something called a [INAUDIBLE] shelter, I think it was called-- that was half buried with corrugated iron as the top thing. And if the siren went, I can remember that we would have to go out and get into the shelter. And we could hear the V-1s very, very-- I can still remember. You can hear the V-1s coming over. It made a hum-- [HUMMING] --like that. And it's gradually getting louder and louder, and then it would stop, and then it would just fall out of the sky at an angle. It would go down at about 45 degrees. So if you could hear the [? stop ?] overhead, you weren't going to be hit. But if you could hear the [? stop ?] coming towards you, there was a chance you were going to get hit. I can remember that. Everybody was sitting listening to where these bombs were cutting out their engine. So that's one of the things I can remember. And I can remember the V-2. It was a huge bang if one went off. I know that you and Ray both also developed tuberculosis as young boys. What was the background behind that, and how were you treated? Yeah, Ray-- we'd just finished school. And we weren't sure what we were going to do, and Ray had developed [INAUDIBLE], which again didn't mean anything to me. He coughed up a couple of times or [INAUDIBLE] of blood. And the next thing he's carted off and he's got tuberculosis, and he's been taken down to a sanatorium down near the Thames out along the marshes sort of thing. And he's there for six months. And during that six months, I can't see him and everything, and I thought, "Well, you know I'd like to do medicine. I think this is rather a good thing." So what I did, I then applied for medical school and got a place. And then Ray gets better, and he then applies to medical school, and he gets a place as well. The dean said to Ray when he saw it, he said, "Haven't we seen you here before?" And Ray said, "No, it's my twin brother." And he then says, "Did we accept him?" And Ray said, "Yes." And then he said, "Pity." [LAUGHTER] And it was the end of the interview. The next thing, he's in as well. [LAUGHTER] And then I get TB, because it's about an 80% chance you get it if an identical twin's had it. And I was in the hospital for three months. So we were both back a year. I would have been a year ahead of Ray, but in fact then suddenly we're both back a year. And it was quite an interesting year for me, because I only had one subject to do. So I was able to do some reading, things like Darwin and that sort of stuff. And then we just carried on. And you were treated with streptomycin in those days? [INAUDIBLE]. You had 50 grams of strep. Yeah, yeah. Sounds like you used that as a springboard to change the practice of medicine. So in every cloud there's a silver lining. The one thing I want to bring up-- I remember several years ago at one of the San Antonio meetings, and you and Dr. [? Bernie ?] Fisher were the bait. And he did all but call for you to be arrested and locked up because your study was negative, and of course the [? PL1 ?] one was positive. And you very graciously responded to that, "You know, Dr. Fisher, I didn't start this trial up to be negative." [LAUGHTER] That was a great response. My goodness did I not admire him. The reason I did the trial is-- again, this is a funny story. I did a lot of horse riding, as you know. And what I did is after the 1985 first meta analysis, Oxford meta analysis, that was the first one to show that chemotherapy worked for the [INAUDIBLE] and other trials that chemotherapies show the reduction. And it showed that tamoxifen worked. That was the first meeting where I was really convinced that both those were positive effects. Up till then, it was one trial and you couldn't be sure if it was going to be reproduced all the like. And that was the 1985 meta analysis meeting in Oxford. And then I came back home, and I got on my horse, and I rode for a week. I took the horse down to the South Downs. The South Downs is a long, expansive country, and it took me five days, I think it was, of riding to get across from one side to the other where I'd stop in a pub. I had to go down the week before and plan out exactly what I was going to do. So I've got five days on a horseback thinking, and that was where I thought, "Well, where do we go from here?" You might say, well, let's do bigger and better chemo or the like, right? And you might say endocrine therapy, let's do more tamoxifen, or different doses, or [INAUDIBLE] down those paths. So I said, "But if you really want to do something different, the two things you could do would be for chemotherapy is why not give it before surgery?" That was the time when I really thought neoadjuvant chemotherapy was where we ought to be going, because then we could see that they're responding or not et cetera. But tamoxifen, if it weren't for adjuvant therapy, then it should work for prevention. We had a clinic at the Marsden that I took over because somebody was leaving-- which was a family history clinic, and they all had very strong family histories three or four relatives, et cetera, et cetera. And I took over this clinic, and I thought to myself we could do a prevention trial here with tamoxifen. We'll do a pilot. What happened at the Marsden they just had a ethics committee set up, one of the first in the world. This is in 1985. And it had never met, it had only passed the trials to be done. And so the first meeting of the ethics committee at the Marsden was to discuss the prevention, because it was such a awful thing to do. Do you know what I mean? And but after two or three goes, I got it through the ethics committee mainly because a colleague of mine who was the head of medicine then was Tim McIlwain. He pushed it through because he said "Look, it makes so much sense." And we did a [INAUDIBLE] and we had an agreement that we could do 250 patients randomized, then go to 500. And then we had a national meeting to discuss setting up the national program. And so it was a feasibility trial actually looking to see what the toxicity was or whether it was acceptable to do it. And we had such a spin off from that, because tamoxifen at that stage was supposed to be a pure anti estrogen. And we were screening all the tissues, we were doing bones that [INAUDIBLE] from the clotting factors. Everything. Cholesterol. We were doing, measuring everything in pre and post menopausal women. And everywhere we looked, tamoxifen wasn't acting as an anti estrogen. It was acting as an estrogen effect, so much so that at the Think Tank-- I presented it at the Think Tank, and I said, "Look these aren't [INAUDIBLE] tamoxifen and anti estrogen at all." And I thought Mark, dear old Mark Lippert, was going to have an epilepsy, which 'cause it's correct because it is an anti estrogen breast cancer effect. But that was the first time. So then in the paper I wrote, I called it a selective anti estrogen. But I didn't coin [INAUDIBLE], but I did coin the expression, the first published thing of a selective anti estrogen. I remember that paper. [INAUDIBLE]. I remember that. So I want to finish up with just-- Let me just finish up one thing. Can I just finish up one thing? [INTERPOSING VOICES] Because it links into [INAUDIBLE]. So after Think Tank presented it possibly as an estrogen. And what was happening is we've got a bell shaped curve that was very narrow. So we were on the estrogen side as opposed to the anti estrogen side, right? And that was what was happening in the normal tissues. So I had a slides that said, "Tamoxifen is not an anti estrogen." You probably remember if you were there. You were there. We go out on the boat, and we get stranded out of the boat in the mist-- the one you've mentioned about where you and I and Mark, et cetera-- when we're approaching the time after about four hours when we're thinking about meeting our maker, Mark says to me, "I've really got to have a word with you about this anti estrogen." Well one other thing-- and this is going to be more my talking than yours. I really just touched on the surface of your contributions to the field, but I think probably the greatest is your mentoring history. And you've already hit on a few of these, but I travel extensively and I'm struck by the number of times I've been in some remote area-- or at least remote to me-- and corner of the world, and somebody-- it's usually my host-- volunteers that he or she trained at the Royal Marsden with Trevor Powles. And I think it's one of the things you should be most proud of all the many things you've done. And I want to know that you set up a system that was opening and inviting and also somehow funded to support people to come from all over the world. What made you do that? How did you do that in the first place? It's hard to do. Certain people came to me, which was very nice. We did have funds. I would be able to get funding even at that stage. There are many more hurdles for getting funding now than there were then. And the other thing about it was the fact that I find that people-- many times we've [INAUDIBLE] [? mentioning ?] things-- but one of the things I really did [? let ?] is let people have the run of doing things as opposed to me doing it maybe with the assistant. And that was very rewarding for me in terms of results and [INAUDIBLE], 'cause people were very motivated to do it, people like you, and Charlie, and the others. So in some senses, I think it was the fact I was looking for the results we wanted to get rather than anything else. That's probably the basis of it, and therefore people came who ere good. And I'm very lucky I had very, very good people come. So just to go through the list briefly-- Ian Smith, Mitch Dowsett, Troy [? Kohns, ?] Adrian Harris, Paul Goss, who am I leaving out? Anyway, it's a who's who of breast cancer, especially endocrinology and breast cancer. And they all came out of your brilliance. So we owe you not just for what you've done, but who you've trained to do even more. Very kind of you to say that, but in fact they get the credit because if you look through my publication lists you can see.     Actually, I left out Steven Johnston, of course, who is-- Steve. Yeah, Steve. Yeah. OK, we've run out of time. I very much appreciate the fact that you've taken time to come on and do that for us. I'm sure our listeners will be thrilled by the stories you've told-- at least I always am-- and it's great to hear most of them again. And I hope sometime we can even do this again. So thank you for all you've done, thank you for all the people you've trained, and thank you for taking time to do this today. Well, thank you so much for asking me.   Until next time, thank you for listening to this JCO's Cancer Story-- The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories-- The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org.

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This episode is part of our special Ralph Lauren Cancer Conversations series recorded at The Conduit. Throughout this series, we will invite people touched by cancer to share their stories. We will also be delving into the science behind cancer research, the role of technology in early detection and prevention, and how innovative collaborations in cancer research and philanthropy can achieve amazing results.  Paul's guest today is the author, podcaster and campaigner, Deborah James. They talk about the process she went through after being diagnosed with bowel cancer, the support she's received from The Royal Marsden and why she continues to share her story.

This episode launches our special Ralph Lauren Cancer Conversations series recorded at The Conduit. Throughout this series, we will invite people touched by cancer to share their stories. We will also be delving into the science behind cancer research, the role of technology in early detection and prevention, and how innovative collaborations in cancer research and philanthropy can achieve amazing results.  Paul's guest today is Andrew Fisher OBE, former CEO and Executive Chairman of Shazam, and Member of The Royal Marsden Cancer Charity's Oak Cancer Centre Appeal Board. They discuss the link between the science behind Shazam and his work with The Royal Marsden, the role of data in providing cancer care, and how to motivate people of all ages to engage with your cause.

​In this episode we hear from Bpositive founder Jonjo Rooney who shares his experience in facing treatment for acute lymphoblastic leukaemia, after he was diagnosed in December 2016. This recording was taken from when Jonjo was asked to share his story to a group of professionals training as haemo-oncology nurses at The Royal Marsden school in London, earlier this year (2019). 

In this episode we hear from Flora Dangwa, a former Clinical Nurse Specialist from the Royal Free hospital and UCLH. Flora, now enjoying her new role as a Lecturer Practitioner at The Royal Marsden, speaks about how important CNS professionals are to patients during treatment for leukaemia and, indeed, all cancers, and how, today, there’s much more focus on supporting patients more holistically and with their mental health and wellbeing in mind throughout their illness.

In our final episode of series 1 of our podcast we discuss diet, which can cause a lot of confusion and anxiety for women who are worried about their risk of breast cancer or the chance of it coming back. In a recording from our Facebook Live video, our nurse Addie speaks to Rav, a dietician at the Royal Marsden hospital. They chat about diet myths and breast cancer risk and recurrence, diet advice during and after treatment, and how to get referred to a dietician. Stay tuned and subscribe so you're the first to hear series 2 of the Breast Cancer Care podcast.

Vicki Woodall, whose son George was diagnosed at the age of five, shares her experiences with Lauren Mahon, Deborah James and Steve Bland. Tierney Kinsella, who was diagnosed with cancer at 14 and has been in treatment for the past four years, tells her story. Plus Dr Julia Chisholm, Consultant Paediatric and Adolescent Oncologist at the Royal Marsden, joins the team to answer their questions and talk about the intricacies of treating children with cancer. Radio 1’s Chris Stark, who played a big role in getting You, Me and the Big C to the top of the podcast charts, calls in for a quick chat.

The amazing Deborah James is a campaigner and co-presenter of the top-charting podcast You, Me and the Big C, which takes listeners through every twist and turn, showing how you can still live your life and be yourself with cancer.Deborah was a deputy head teacher before at the age of 35, being diagnosed with bowel cancer and her life with her young children and husband was thrown upside down. She’s had 4 major operations including bowel and lung resections and multiple rounds of chemo – and is still undergoing treatment at the Royal Marsden. She started a blog called 'Bowel Babe’ to debunk the myth that young women don't get bowel cancer and writes a weekly column for the Sun online, "Things Cancer Made Me Say". She campaigns alongside major UK cancer charities, writes and presents the popular podcast ‘You, Me & the Big C’ for BBC’s Radio 5 Live, and has a built up a strong following on Instagram, please follow her: @bowelbabe.Debora's book 'F**k You Cancer' is out now, an inspiring cancer guide that encourages you to shout #F*CKYOUCANCER.I found this episode so inspiring and moving and informative and I hope you do too.You can find Deborah on Instagram here: https://www.instagram.com/bowelbabe/Her book here: https://www.amazon.co.uk/You-Cancer-face-still-yourself/dp/178504205XPodcast 'You Me & The Big C": https://www.bbc.co.uk/programmes/p0608649 See acast.com/privacy for privacy and opt-out information.

Copycat biologic drugs, to treat conditions from arthritis and psoriasis to breast cancer and lymphoma, could save hundreds of millions of pounds off the NHS drugs bill. Called biosimilars, these close copies give the same clinical benefit at a fraction of the cost. Up to now the problem has been take-up, but a new initiative led by the specialist UK cancer centre, London's Royal Marsden, run across the NHS Cancer Vanguard, has demonstrated that patients can be switched effectively onto the cheaper drugs. Chief pharmacist at the Royal Marsden, Dr Jatinder Harchowal, who led the national staff education programme, tells Mark that getting clinicians and patients on board was key to achieving an 80% take up for the blood cancer biosimilar, rituximab. This month a biosimilar copy of the breast and stomach cancer drug, Herceptin (generic name trastuzumab) is being introduced to patients too. Imogen had sleep problems for almost 30 years and she admits that at times, her insomnia left her in a desperate state. For years she took sleeping tablets but she ended up increasing the dosage, to no effect. Eventually she found help at Queen Victoria Hospital's Sleep Disorder Clinic in East Grinstead. Mark visits the clinic and finds out from its Clinical Director Dr Peter Venn that sleeping tablets aren't the answer to insomnia and cognitive behaviour therapy, which Imogen used, is the best treatment. Scotland has led the UK nations in allowing early medical abortion at home. Wales in the past 10 days has followed their lead. So where does this leave England? Dr Margaret McCartney reports from Glasgow about the choice now available for Scottish women who opt for a medical termination. Since last autumn the second pill that induces the breakdown of the womb lining can be taken at home, a practice that already happens in Scandinavia and parts of the USA. Dr Audrey Brown, a consultant in sexual and reproductive healthcare, tells Margaret that the impetus for the change in practice in Scotland came directly from women who didn't want to make the second clinic visit for the second set of drugs and risk cramping and bleeding on the way home. A woman who has opted for early medical abortion at home in Scotland shares her experience with Inside Health. Producer: Fiona Hill.

The girls look into the future of cancer care. They talk to Dr Fiona Thistlethwaite from The Christie who is looking after Rachael’s current drug trial. They also speak to Professor David Cunningham from the Royal Marsden who over sees Deborah’s medical team about his thoughts on where cancer treatment is heading.

The #youmebigc team, Rachael, Deborah and Lauren give you their personal guide to all things chemo. They are joined by chemotherapy nurse Kate Lewis from The Royal Marsden who shares her advice and expertise.

Thanks for checking out our second Art of Dying Well podcast. As ever, the aim's to make dying something we don't have to walk through alone. This month we're talking about palliative care with the wonderful and hugely experienced Dr Kathryn Mannix who has worked in palliative and end of life care for over 30 years. April's 'Death Chatter' looks at a subject we covered in our March podcast - children dealing with grief - focusing particularly on two programmes. The first, a BBC documentary in which ex-England footballer Rio Ferdinand discusses losing his wife to cancer and the subsequent challenges bringing up three young children and, the other, a Telegraph podcast in which Prince Harry speaks about how he pushed feelings of grief away for 20 years after the death of his iconic mother Princess Diana. We finish with 'The View from the Chaplain's Chair' joining Fr George Bowen, a former hospital chaplain at the Royal Brompton and also the Royal Marsden.

Dr Naureen Starling is a Consultant Medical Oncologist at The Royal Marsden hospital in London, specialising in the treatment of gastrointestinal cancers. She is better known to listeners as Steve Hewlett's doctor. She explained to Eddie Mair that one thing she has learnt whilst treating Steve was that clear communication was vital. "I think it's often good for me and my colleagues just to step back and think actually am I communicating this clearly in a way the patient can understand."

Professor Gareth Morgan from The Royal Marsden, UK, talks to ecancerTV about how far treatment in myeloma has come over the past decade. Also where it is likely to go in the coming years as the use of newer agents are fine-tuned to further improve outcomes. He focuses on new data from ASH 2012 such as maintenance treatment with lenalidomide and bortezomib, and notes how newer agents have considerably improved patients’ quality of life. The challenge of whether to use single or combination agents remains, although Professor Morgan notes the additional challenge of toxicity in older patients with the use of combination agents. He points to the data on quadruplets of therapy presented at ASH 2012, and questions the use of this over triplets of therapy. Professor Morgan looks forward to the increased use of treatments according to laboratory sub-types, for example, using profiling to characterise mutational landscapes and sequencing to prevent the emergence of resistance in myeloma.

Professor Gareth Morgan from The Royal Marsden, UK, talks to ecancerTV about how far treatment in myeloma has come over the past decade. Also where it is likely to go in the coming years as the use of newer agents are fine-tuned to further improve outcomes. He focuses on new data from ASH 2012 such as maintenance treatment with lenalidomide and bortezomib, and notes how newer agents have considerably improved patients’ quality of life. The challenge of whether to use single or combination agents remains, although Professor Morgan notes the additional challenge of toxicity in older patients with the use of combination agents. He points to the data on quadruplets of therapy presented at ASH 2012, and questions the use of this over triplets of therapy. Professor Morgan looks forward to the increased use of treatments according to laboratory sub-types, for example, using profiling to characterise mutational landscapes and sequencing to prevent the emergence of resistance in myeloma.

Interview with Faith Davies, Consultant Haematologist at The Royal Marsden, London and Group leader at the Insititute of Cancer Research in London. Prof. Davies discusses the topic 'Biological characterization of multiple myeloma'.The interview is led by Shaun McCann, Chair of EHATol Unit, Member of EHA Education Committee.

Interview with Faith Davies, Consultant Haematologist at The Royal Marsden, London and Group leader at the Insititute of Cancer Research in London. Prof. Davies discusses the topic 'Biological characterization of multiple myeloma'.The interview is led by Shaun McCann, Chair of EHATol Unit, Member of EHA Education Committee.